Background: Adverse maternal and perinatal outcomes remain a major public health concern, particularly in tertiary care settings managing high-risk pregnancies. Early identification of clinical and biochemical predictors during pregnancy may help in timely intervention and improved outcomes.

Aim: To evaluate clinical and biochemical predictors of adverse maternal and perinatal outcomes in pregnant women.

Materials and Methods: A hospital-based prospective observational analytical study was conducted over 12 months among 180 pregnant women attending a tertiary care hospital. Eligible participants with singleton pregnancies of ≥20 weeks gestation were enrolled using consecutive sampling and followed until delivery. Clinical parameters, including blood pressure and obstetric history, and biochemical markers such as hemoglobin, blood glucose, and serum uric acid were recorded. Maternal and perinatal outcomes were documented. Data were analyzed using appropriate descriptive and inferential statistical tests, and multivariate logistic regression was applied to identify independent predictors. A p-value <0.05 was considered statistically significant.

Results: A significant association was observed between maternal hypertension, anemia, hyperglycemia, and elevated serum uric acid levels with adverse maternal and perinatal outcomes (p<0.05). Multivariate analysis identified hypertension and elevated serum uric acid as strong independent predictors. Women with these risk factors had higher rates of complications such as preterm delivery, low birth weight, and need for neonatal intensive care.

Conclusion: Clinical and biochemical parameters are valuable predictors of adverse pregnancy outcomes. Routine antenatal screening and early risk stratification can improve maternal and neonatal prognosis through timely management.

Keywords: Pregnancy, Maternal Outcomes, Perinatal Outcomes, Biochemical Predictors, Hypertension, Anemia.