Introduction: Thyroid disorders, the second most common endocrinologic issue in pregnant women, even get extended to subclinical hypothyroidism (SCH), which is a condition associated with the risk of pregnancy complications and also adverse effects on the baby's neuropsychological development. This study aims to assess the frequency of SCH and anti-TPO antibodies in pregnant women and compare the outcomes to those of women without thyroid issues. Materials and methods: A hospital-based observational study was conducted as an observational study in a tertiary teaching hospital, 500 pregnant women aged 18–40 underwent thyroid functioning and anti-TPO antibody testing. Cases were managed on the basis of their thyroid and TPO statuses, with comprehensive follow-ups tracking maternal details during antenatal, intrapartum, and postpartum periods, too. Neonatal outcomes, including APGAR scores, Neonatal Intensive Care Unit (NICU) care, and baby weights was documented. Neonatal S.TSH levels were assessed post-birth. Results: Prevalence rates in our study were 32% for SCH, 1.98% for overt hypothyroidism, and 66.02% for euthyroid cases. Out of the 184 patients with SCH, 85 (46.20%) tested positive for anti-TPO antibodies. Women with SCH exhibited a significantly higher rate of cesarean sections; SCH with anti-TPO-Ab positivity correlated notably with preterm delivery, premature rupture of membranes, and hyperbilirubinemia. Conclusion: The study shows that one in three antenatal care patients screened for thyroid disorders was diagnosed with SCH. The condition is linked to complications including an increased incidence of elevated cesarean section rates and NICU admissions compared to pregnant women with a euthyroid state. Clinical significance: Testing for thyroid function and anti-TPO ought to be a routine for every pregnant woman so that they can promptly identify SCH and prevent potential complications associated with pregnancy.