Objective: To investigate the effect of serum cortisol level on perinatal prognosis in patients with hypertensive disorder during pregnancy. Methods: In this study, different degrees of patients with hypertensive disorder during pregnancy who were admitted from August 2018 to August 2019 in our hospital were selected as the research subjects, and divided into groups according to the severity of the patients' conditions. The 120 patients were divided into gestational hypertension group, preeclampsia group and eclampsia group, with 40 cases each, and another 40 healthy pregnant women were selected. The detection of serum cortisol levels was carried out for the above 4 groups of pregnant women. Results: The serum cortisol level in the control group was (260.35 ± 10.96) nmol / L. The case number of neonatal asphyxia was 1 (2.50%), the case number of premature births was 1 (2.50%), the number of fetal growth restriction was 1 (2.50%), the number of deaths was 0, and the other three groups were higher than this. It showed as gestational hypertension <preeclampsia <eclampsia. The Apgar score of pregnant women in the control group was (9.13 ± 0.29), the ZL index was (1.07 ± 0.07), and the other three groups were lower than this. It showed as gestational hypertension> preeclampsia> eclampsia. There were significant differences between groups (all P<0.05). Conclusion: Early detection of serum cortisol levels in pregnant women is beneficial to timely improve the symptoms of gestational hypertension, thereby suppressing the effects of serum cortisol on perinatal infants and improving the prognosis of newborns.