Background:　Thrombophilia　combined　with　pregnancy　poses　significant　risks　for　adverse　pregnancy　outcomes.　Unfortunately,　there　are　no　indicators　at　high　risk　for　predicting　adverse　pregnancy　outcomes.　This　study　investigates　the　predictive　efficiency　of　serum　immune-inflammatory　markers　on　adverse　pregnancy　outcomes.　Methods:　This　retrospective　cohort　study　includes　223　pregnant　women　diagnosed　with　thrombophilia　who　delivered　at　the　Fujian　Provincial　Hospital　South　Branch　from　January　2022　to　April　2024.　Clinical　information　and　pregnancy　outcomes　were　collected.　The　systemic　immune-inflammation　index　(SII),　systemic　inflammation　response　index　(SIRI),　and　lactate　dehydrogenase　(LDH)　were　calculated　using　blood　samples.　The　relationship　and　predictive　accuracy　between　immune-inflammatory　markers　and　adverse　pregnancy　outcomes　were　analyzed.　Results:　In　this　study,　50　(22.4%)　patients　had　adverse　pregnancy　outcomes.　Significant　differences　were　observed　in　neutrophils　counts,　monocytes　counts,　LDH,　SII,　and　SIRI　levels　between　the　adverse　pregnancy　outcome　groups　(APOs)　and　the　control　groups　(P＜0.05).　The　area　under　the　receiver　operating　characteristic　(ROC)　curve　analysis　revealed　that　SII　(AUC=0.762),　SIRI　(AUC=0.764),　and　LDH　(AUC=0.732)　had　high　predictive　values　for　adverse　pregnancy　outcomes.　Notably,　the　combined　model　had　the　highest　AUC　of　0.805.　Multivariate　logistic　regression　identified　SII　had　the　highest　odd　ratio　(OR)　(OR=8.512;　95%　CI　(3.068-23.614)),　followed　by　LDH　(OR=4.905;　95%　CI　(1.167-11.101)),　SIRI　(OR=3.549;　95%　CI(0.847-8.669)),　and　neutrophils　count　(OR=1.726;　95%　CI　(0.563-2.938))　as　independent　risk　factors　for　adverse　outcomes.　Conclusion:　Elevated　levels　of　immune-inflammatory　markers　such　as　SII,　SIRI,　and　LDH　level　are　strong　predictors　of　adverse　pregnancy　outcomes　in　thrombophilia-complicated　pregnancies.　These　markers　are　significantly　associated　with　maternal-neonatal　outcomes.　Our　findings　underscore　the　importance　of　monitoring　immune-inflammatory　markers　in　pregnant　women　with　thrombophilia　to　improve　maternal　and　neonatal　outcomes.