Preeclampsia is the main cause of maternal and perinatal death, especially in developing countries. Multiple studies suggest that blood lead levels in pregnancy are a risk factor for preeclampsia, even with low levels of blood lead. But less knows the dose-effect relationship of preeclampsia in low blood lead levels. This study aims to assess the association between blood lead levels and preeclampsia and to explore its dose-effect relationship between low blood lead levels and preeclampsia. The retrospective cohort study was consecutively conducted in a comprehensive tertiary hospital in Foshan city of Guangdong Province, China, from August 1, 2019, to November 30, 2019. Blood lead levels were measured in maternal whole blood in 12-27 (+6) weeks of pregnancy, using atomic absorption spectrometer. Preeclampsia diagnosis was ascertained from the electronic medical records system. The risk of preeclampsia was estimated by multivariable logical regression analysis, and a two-stage linear regression model was established to find out the dose-effect. A total of 2174 people were included in this study, and 59 (2.7%) women developed preeclampsia. The dose-effect analysis revealed a non-linear association between blood lead levels and the risk of preeclampsia, with a cut-off point at 4.2 μg/dl. When blood lead levels were over 4.2 μg/dl, the risk of preeclampsia increased significantly with an increase in blood lead levels (OR = 2.05, 95%CI: 1.50, 2.81). In the multivariate regression models, per 1 μg/dl increment in blood lead levels was associated with 43% higher risk of developing preeclampsia (OR = 1.43,95%CI:1.17,1.74). Moreover, the association between blood lead levels and preeclampsia was stable in different subgroups. Low levels of lead exposure had a dose-effect relationship of preeclampsia, with a cut-off point at 4.2 μg/dl. Blood lead levels had a non-linear association with preeclampsia. When the blood lead levels were higher than 4.2 μg/dl, the risk of preeclampsia increases by 105% for every 1 μg/dl increase in blood lead levels. Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.