Background <p>Pre-eclampsia is a major cause of maternal and perinatal morbidity and mortality, particularly in low-resource settings. While hypertension and proteinuria are central to diagnosis, additional biomarkers may assist in classifying disease severity at presentation. Serum uric acid (SUA) has been linked to endothelial dysfunction and oxidative stress in pre-eclampsia, but evidence from Somalia is limited.</p> Objective <p>To assess the diagnostic performance of serum uric acid in classifying pre-eclampsia severity and to compare its discriminatory ability with semi-quantitative proteinuria among pregnant women attending Banadir Hospital, Mogadishu, Somalia.</p> Methods <p>A hospital-based comparative cross-sectional study was conducted among 322 pregnant women (161 normotensive controls and 161 women with pre-eclampsia) at Banadir Hospital. Pre-eclampsia cases were classified into non-severe and severe disease based on standard clinical criteria. Serum uric acid levels and urine protein were measured at presentation. Receiver operating characteristic (ROC) curve analysis was used to evaluate the ability of serum uric acid and proteinuria to discriminate severe from non-severe pre-eclampsia, and areas under the curve (AUCs) were compared using the DeLong test.</p> Results <p>Serum uric acid levels increased progressively from normotensive pregnancy to non-severe and severe pre-eclampsia (<i>p</i> &lt; 0.001). Women with severe pre-eclampsia had significantly higher serum uric acid and proteinuria levels compared with those without severe features. Serum uric acid demonstrated excellent discriminatory performance for classifying disease severity (AUC = 0.985; 95% CI: 0.972–0.998). Internal validation using bootstrap resampling (5,000 iterations) confirmed stable performance (bootstrap AUC = 0.985; 95% CI: 0.970–0.997). The optimal cut-off value for serum uric acid was 7.0&#xa0;mg/dL, which yielded a sensitivity of 95.1% and a specificity of 96.3%. Proteinuria showed comparable performance (AUC = 0.986; 95% CI: 0.978–0.995; bootstrap AUC = 0.986; 95% CI: 0.977–0.994), with no statistically significant difference between the two biomarkers (<i>p</i> &gt; 0.05).</p> Conclusion <p>Serum uric acid was significantly associated with pre-eclampsia severity and demonstrated excellent ability to discriminate severe from non-severe disease at presentation, comparable to semi-quantitative proteinuria. Serum uric acid may serve as a useful complementary laboratory marker for severity classification in tertiary referral settings, particularly in low-resource environments.</p>