Background. Liver function tests are routinely performed in women with pre-eclampsia as part of a battery of investigations to assess severity at admission and later to guide appropriate management. Objective. To determine the accuracy with which liver function tests predict complications in women with pre-eclampsia by a systematic review. Data sources. We conducted electronic searches without language restrictions in Medline (1951-2010), Embase (1980-2010) and the Cochrane Library (2009). Methods of study selection. Primary articles that evaluated the accuracy of liver function tests in predicting complications in women with pre-eclampsia were chosen. Data was extracted by two reviewers independently. A bivariate model estimated Area Under the Curve, sensitivity and specificity. Results. There were 13 primary articles including a total of 3497 women assessing maternal (30 2 × 2 tables) and fetal (19 2 × 2 tables) outcomes. For predicting adverse maternal outcome, the point estimates of specificity were > 70% in 18 tables with Area Under the Curve of 0.79 (95% CI 0.51, 0.93). For predicting adverse fetal outcomes the specificity of the test was >70% in 9 2×2 tables. Sensitivity of the test was poor for both maternal and fetal outcomes. Conclusion. Liver function tests performed better in predicting adverse maternal than fetal outcomes in women with pre-eclampsia. Presence of increased liver enzymes was associated with an increased probability of maternal and fetal complications, but normal liver enzymes did not rule out disease, as specificity was often higher than sensitivity.