Background <p>Preeclampsia (PE) is a pregnancy-associated disease that result in maternal and fetal morbidity and mortality worldwide. Several studies demonstrated the alterations in miRs (miRNAs) expression in PE. The aim of the present study was to determine the expression level of miR-181 and whether miR-181 have a diagnostic value in detection of women with PE compared to women without PE.</p> Methods <p>A systematic review and meta-analysis were performed based on studies reporting the miRNA expression level of miR-181 in placenta or serum between pregnant women with and without PE. Thus, articles published up to December 17, 2024 were extracted through PubMed, Scopus, Web of Science and Embase. The electronic literature search was conducted independently by two authors to obtain eligible studies based on the screening of title, abstract and full-text and quality appraisal. Subgroup analyses, area under the curve (AUC) were calculated. Standardized mean difference (SMD) was applied as a measure of pooled effect size.</p> Results <p>Twelve studies were included in the systematic review and meta-analysis based on inclusion criteria. The results show that the expression level of miR-181 is significantly higher in women with PE compared to women without PE (SMD = 1.84, 95%CI 0.47–3.21, <i>p</i> = 0.008). No publication bias was observed using the Begg’s rank correlation (<i>p</i> = 0.20) and Egger’s linear regression (<i>p</i> = 0.57) tests. Subgroup analyses demonstrated significant correlation between miR-181 levels in placenta or serum with maternal age, gestational age at delivery and birth weight. In addition, the pooled AUC was (0.95 ± 0.038; <i>p</i> &lt; 0.0001) that shows the high diagnostic value of miR-181 in women with PE.</p> Conclusions <p>miR-181 can be a promising potential biomarker in the early detection of women with PE compared to women without PE. Albeit, further studies are needed for the more confirmation and validation this result.</p>