Objective To analyze the predictive value of serum peroxisome proliferator-activated receptor-γ co-activator 1α (PGC-1α), GATA binding protein 3 (GATA-3) and insulin-like growth factor binding protein-3 (IGFBP-3) in patients with hypertensive disorders complicating pregnancy combined with Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome.Methods The clinical data of 179 patients with hypertensive disorders complicating pregnancy admitted to our hospital from February 2021 to March 2024 were retrospectively analyzed. According to whether the patients were complicated by HELLP syndrome, they were divided into a concurrent group (n = 13) and a non-concurrent group (n = 166). The clinical data and serum levels of PGC-1α, GATA-3 and IGFBP-3 were compared between the concurrent group and the non-concurrent group. The factors affecting the occurrence of HELLP syndrome were analyzed, and the receiver operating characteristic (ROC) curve was plotted to assess their predictive values.Results The concurrent group had a higher proportion of patients aged ≥35 years, with more than five pregnancies, a higher BMI, and a greater percentage of cases with ≤3 prenatal visits compared to the non-concurrent group (P < 0.05). The serum levels of PGC-1α and GATA-3 in the concurrent group were lower than those in the non-concurrent group (P < 0.05), and the levels of IGFBP-3 in the concurrent group were higher than those in the non-concurrent group (P < 0.05). The multivariable Logistic regression analysis demonstrated that age ≥35 years [O^R = 4.816 (95% CI: 2.117, 10.956)] and high serum IGFBP-3 levels [O^R = 3.062 (95% CI: 1.346, 6.965) ] were risk factors for HELLP syndrome in patients with hypertensive disorders complicating pregnancy (P < 0.05). High serum levels of PGC-1α [O^R = 0.277 (95% CI: 0.122, 0.630) ] and GATA-3 [O^R = 0.262 (95% CI: 0.115, 0.595) ] were protective factors for HELLP syndrome in patients with hypertensive disorders complicating pregnancy (P < 0.05). The ROC curve analysis suggested that the sensitivities of serum levels of PGC-1α, GADA-3, IGFBP-3 and their combination for predicting the HELLP syndrome in patients with hypertensive disorders complicating pregnancy were 84.62% (95% CI: 0.537, 0.973), 92.31% (95% CI: 0.621, 0.996), 84.62% (95% CI: 0.537, 0.937), and 92.31% (95% CI: 0.621, 0.996), with the specificities being 72.89% (95% CI: 0.653, 0.794), 72.89% (0.653, 0.794), 83.13% (95% CI: 0.764, 0.883), and 93.98% (95% CI: 0.889, 0.969).Conclusion Serum levels of PGC-1α, GATA-3 and IGFBP-3 have significant value in predicting HELLP syndrome in patients with hypertensive disorders complicating pregnancy, and their combination yields higher predictive value.