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Context Overweight and obesity among Indian women of reproductive age are increasing, posing important risks for pregnancy, particularly in primigravid women. Evidence focused solely on primigravid women remains limited. Aim This study aims to assess maternal and foetal outcomes among primigravid women with high body mass index (BMI) attending a tertiary care hospital in Kolkata. Settings and design This is a prospective observational study conducted over one year in a tertiary care obstetric unit. Methods and materials A total of 144 primigravid women enrolled at ≤12 weeks of gestation were categorised into normal BMI (18.5-24.9 kg/m²) and high BMI (≥25 kg/m²). Maternal outcomes included hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), labour and delivery complications. Foetal outcomes assessed were preterm birth, neonatal morbidity, and NICU admission. Logistic regression was used to estimate adjusted odds ratios (AOR). Results A high BMI was present in 40.3% of participants. High BMI was significantly associated with HDP and GDM. Labour complications and delivery complications were also more frequent. Infants of high-BMI mothers showed higher odds of being born preterm and of NICU admission. Conclusions High early-pregnancy BMI is an important predictor of adverse maternal and neonatal outcomes in primigravid women. Early BMI screening, focused antenatal surveillance, and preconception counselling are essential for risk reduction.