Background: Preeclampsia is a significant pregnancy complication characterized by high blood pressure and potential organ damage, posing substantial risks to both maternal and neonatal health. This study aimed to identify the risk factors and obstetrical outcomes associated with preeclampsia among Omani women. Methods: A case-control study was conducted at two tertiary hospitals in Oman. Data collected retrospectively from 668 women (167 with preeclampsia and 501 controls) were analyzed. Demographic, obstetric, and clinical variables were examined using Pearson chi-square tests and independent t-tests. Binary logistic regression was employed to determine independent predictors of preeclampsia. Results: Preeclampsia prevalence was 3.57%. Significant risk factors included higher gravidity (χ²(2, N=668) = 8.194, p = 0.017) and parity (χ²(3, N=668) = 18.113, p 0.001). Women with preeclampsia had significantly higher systolic (t(666) = 26.974, p 0.001) and diastolic (t(666) = 24.580, p 0.001) blood pressure compared to controls. Obstetric outcomes revealed earlier gestational age at delivery (37 weeks), more cesarean sections (64.1% vs. 15.6% in controls), and increased complications, including eclampsia, placental abruption, and HELLP syndrome (p 0.001). Neonatal outcomes included lower Apgar scores at 1 and 5 minutes (p 0.001), higher rates of low birth weight (2.5 kg) (p 0.001), and significantly more NICU admissions (38.3% vs. 3.6%, p 0.001). Logistic regression identified lower systolic blood pressure as predictive (AoR = 0.784, 95% CI [0.733, 0.837], p 0.001). Gravidity (AoR = 1.529, 95% CI [0.647, 3.616], p = 0.334) and BMI (AoR = 1.019, 95% CI [0.953, 1.089], p = 0.583) showed positive associations but were not statistically significant. Conclusion: Early detection and management of hypertension and higher gravidity are crucial in reducing preeclampsia-related complications in Oman. Targeted prenatal care focusing on these factors can significantly improve maternal and neonatal health outcomes.