High-risk pregnancies contribute disproportionately to maternal illness, stillbirth, preterm birth and neonatal intensive care admission, and India carries a heavy share of this burden. This paper synthesises recent evidence, drawn mainly from retrospective hospital-based studies, a national survey analysis and systematic reviews published between 2023 and 2026, on maternal and fetal outcomes in high-risk pregnancies. The literature was located through structured web-based searches and appraised narratively rather than pooled statistically. Indian reports place the proportion of pregnancies classed as high-risk anywhere between roughly 18% and 65%, depending on the definition applied and the setting studied. Across settings, hypertensive disorders, gestational diabetes, adolescent pregnancy, multiple gestation and nulliparity were repeatedly linked with higher rates of caesarean delivery, antepartum bleeding, preterm birth, low birth weight, poor Apgar scores and neonatal unit admission. Maternal deaths were rare in tertiary-care records, which may reflect timely referral and specialised care. Barriers include inconsistent risk definitions, incomplete screening, socioeconomic disadvantage, uneven access to diagnostics and the inherent limits of record-based designs. Standardised risk stratification, early detection of gestational diabetes and hypertension, and stronger follow-up of women flagged as high-risk are recommended, along with prospective multicentre studies that use harmonised definitions.