Background: The interaction of preeclampsia and infection of influenza could exacerbate oxidative and inflammatory stress and accelerate genomic instability within exposed epithelial cells and derangement in iron balance. Cells from the oral buccal mucosa as a non-invasive surrogate tissue permit non-invasive evaluation of genotoxicity with buccal micronucleus cytome (BMCyt) test. Objective: The aim was to investigate the parameters of DNA damage biomarkers (micronucleus formation and related nuclear changes) and hepcidin, apelin, galectin-3, and iron profile (iron, ferritin, TIBC, UIBC, transferrin, TSAT%) in cells from the buccal mucosa and sera of healthy controls, healthy pregnant women, and preeclampsia patients with influenza infection and to determine discriminatory capability of these biomarkers. Methods: A comparative cross-sectional study comprised 60 healthy controls, 60 healthy pregnant women, and 58 preeclampsia patients with confirmed influenza infection. The BMCyt test was utilized to detect MN, BN, PN, KR, KL, and DIF buccal cells. Serum hepcidin, apelin, and galectin-3 were quantified by ELISA; iron indices were determined using colorimetric/immunoturbidimetric methods. ROC analysis was done to compare healthy pregnant women with preeclampsia patients with influenza. Results: The frequency of MN, BN, and KL and DIF% values were significantly higher in preeclampsia patients with influenza compared to healthy pregnant and control subjects, reflecting an increase in the genotoxic and cytotoxic/degenerative damage. Significantly higher levels of ferritin, hepcidin, and galectin-3, but significantly decreased concentrations of apelin and TSAT% were found in the preeclampsia group in comparison with the healthy pregnant females. The ROC curve analysis revealed that ferritin, hepcidin, MN%, KR%, KL%, BN%, and PN% had the excellent discriminatory power (AUC ≥ 0.92), while the conventional iron-binding protein indicators (TIBC, UIBC, transferrin) and apelin demonstrated a poor-to-failure discriminating capacity. Conclusion: The use of buccal micronucleus cytome criteria along with hepcidin and ferritin allows the prediction of genotoxic and inflammatory disruption in preeclampsia complicated with influenza.