Background: Tuberculosis (TB) remains a major global public health problem, despite that maternal TB remains an obscure and underestimated issue. The prevalence of TB in pregnancy is not well known. The present study is aimed to determine the prevalence of TB and assess the obstetrical and perinatal outcomes of TB in antenatal women. Materials and methods: A prospective observational study was done in a tertiary care center over a period of 1 year from January 2019 to January 2020. Pregnant women in the age-group of 18–42 years diagnosed with TB in the antenatal period were included in our study for evaluating maternal and fetal outcomes. We excluded those antenatal women with a history of TB and adequately treated and cured and those women with TB who did not deliver during the study period. Data collected from individual case record included age, parity, socioeconomic status, time of diagnosis, and complication in antenatal, intrapartum, and postpartum period. The mean birth weight of infants and frequency of small for gestation, stillbirth, neonatal depression, neonatal intensive care unit (NICU) admission, and neonatal death were noted, and perinatal outcome was seen. Results: Five-thousand and two hundred patients delivered during the study period; among those, 70 diagnosed with TB in the antenatal period were included, making a prevalence rate of 1.34/1,000 per pregnant woman. There was a significant increase in the incidence of preterm delivery, anemia, and intrauterine growth restriction in TB. In our study, we found that maternal and perinatal outcomes in pregnant women with TB depend on site, the severity of disease, gestation at diagnosis, and complication of TB. Conclusion: The prevalence of TB in antenatal women at our institute was 1.34/1,000 per pregnant woman. A high suspicion is required to acknowledge the varying disease spectrum and thus complications of TB in antenatal women and initiate treatment early for better outcomes.