To investigate the correlation between the serum circACTR2 and miR-525-5p levels of pregnant women with hypertensive disorder of pregnancy (HDP) and their adverse pregnancy outcomes. Methods: From January 2020 to June 2022, 148 pregnant women with HDP who were filed in hospital and underwent regular prenatal examination were selected in study group, and 100 healthy pregnant women who underwent regular prenatal examination and gave birth in hospital during the same period were selected in control group. The clinical data of the women in the two groups were collected. The women in the two groups were divided into group A (98 women with the normal pregnancy outcomes) and group B (50 women with the adverse pregnancy outcomes) according to whether the adverse pregnancy outcome occurred or not. The expression levels of serum circACTR2 and miR-525-5p of the women in the two groups were detected by real-time fluorescent quantitative PCR. The correlation between the pregnancy outcomes of the women with HDP and their clinicopathological features was analyzed. Spearman method was used to analyze the correlation between the expressions of serum circACTR2 and miR-525-5p of the women with HDP and their adverse pregnancy outcomes. Logisitic regression was used to analyze the influencing factors of the adverse pregnancy outcomes of the women with HDP. Receiver operating characteristic (ROC) curve was used to analyze the value of the serum circACTR2 and miR-525-5p expressions of the women for predicting their adverse pregnancy outcomes. Results: The serum circACTR2 level (1.33±0.35) of the women in the study group was significantly higher than that (1.08±0.27) of the women in the control group, and the miR-525-5p level (0.76±0.21) of the women in the study group was significantly lower than that (1.02±0.30) of the women in the control group (P<0.05). The levels of serum cystatin C (CysC), D-dimer (D-D), C-reactive protein (CRP) and circACTR2 of the women in group B were significantly higher than those of the women in group A, and the level of miR-525-5p of the women in group B was significantly lower than that of the women in group A (P<0.05). The level of serum circACTR2 of the women was positively correlated with their adverse pregnancy outcomes, and the level of serum miR-525-5p of the women was negatively correlated with their adverse pregnancy outcomes (all P<0.05). The abnormalities of the levels of CysC, D-D, CRP, circACTR2 and miR-525-5p of the women with HDP were all the influencing factors of their adverse pregnancy outcomes (P<0.05). The area under the curve of the circACTR2 level combined with miR-525-5p level of the women with HDP for predicting their adverse pregnancy outcomes was 0.877, and the sensitivity and the specificity of which were 76.0% and 86.7%. Conclusion: The expression of the circACTR2 level of the pregnant women with HDP is up-regulated and the expression of miR-525-5p is down-regulated, and both of which are closely related to the adverse pregnancy outcomes of the pregnant women with HDP. The combined detection of the circACTR2 and miR-525-5p levels of the pregnant women with HDP has better efficacy for predicting their adverse pregnancy outcomes.