Objective: To compare pre‐eclampsia risk factors identified by clinical practice guidelines (CPGs) with risk factors from hierarchical evidence review, to guide pre‐eclampsia prevention. Design: Our search strategy provided hierarchical evidence of relationships between risk factors and pre‐eclampsia using Medline (Ovid), searched from January 2010 to January 2021. Setting: Published studies and CPGs. Population Pregnant women. Methods: We evaluated the strength of association and quality of evidence (GRADE). CPGs (n = 15) were taken from a previous systematic review. Main outcome measure: Pre‐eclampsia. Results: Of 78 pre‐eclampsia risk factors, 13 (16.5%) arise only during pregnancy. Strength of association was usually 'probable' (n = 40, 51.3%) and the quality of evidence was low (n = 35, 44.9%). The 'major' and 'moderate' risk factors proposed by 8/15 CPGs were not well aligned with the evidence; of the ten 'major' risk factors (alone warranting aspirin prophylaxis), associations with pre‐eclampsia were definite (n = 4), probable (n = 5) or possible (n = 1), based on moderate (n = 4), low (n = 5) or very low (n = 1) quality evidence. Obesity ('moderate' risk factor) was definitely associated with pre‐eclampsia (high‐quality evidence). The other ten 'moderate' risk factors had probable (n = 8), possible (n = 1) or no (n = 1) association with pre‐eclampsia, based on evidence of moderate (n = 1), low (n = 5) or very low (n = 4) quality. Three risk factors not identified by the CPGs had probable associations (high quality): being overweight; 'prehypertension' at booking; and blood pressure of 130–139/80–89 mmHg in early pregnancy. Conclusions: Pre‐eclampsia risk factors in CPGs are poorly aligned with evidence, particularly for the strongest risk factor of obesity. There is a lack of distinction between risk factors identifiable in early pregnancy and those arising later. A refresh of the strategies advocated by CPGs is needed. Linked article: This article is commented on by Stefan C. Kane et al., pp. 63 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471‐0528.17311. [ABSTRACT FROM AUTHOR]