Background: Pre-eclampsia is a multi-system disorder of pregnancy that contributes considerably to the maternal morbidity and mortality worldwide. Several researchers have found an association between hypocalciuria and the development of pre-eclampsia. Hence, there is a need to test the predictive value of decreased urinary calcium to creatinine ratio in pre-eclampsia. Aim and Objectives: To determine the predictive values of urinary calcium to creatinine ratio for pre-eclampsia, in a spot urine sample, in asymptomatic pregnant women at 16-20 weeks of gestation. Methods: This was a prospective cohort study carried out on pregnant women between 16 and 20 weeks of gestation presenting at antenatal clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto. A pretested structured, interviewer-administered questionnaire was completed for all the participants. Urine sample was taken from each participant for quantification of urinary calcium using O-cresolphthalein complexone reaction and urinary creatinine using the Jaffe’s method. Urinary calcium-creatinine ratio (CCR) was calculated. The participants were followed up till delivery and observed for development of pre-eclampsia. They were then grouped into two groups: group A- women who developed pre-eclampsia, and group B - women who did not develop pre-eclampsia till delivery. The data obtained was analysed using Statistical Package for Social Sciences (SPSS) version 20.