Introduction <p>Women with high Body Mass Index (BMI) are at increased risk of maternal and perinatal complications. These complications range from diabetes, hypertensive disorders, preterm births, increased rates of cesarean births, anesthesia related challenges, macrosomic fetuses, fetal anomalies, stillbirths, postpartum hemorrhage and surgical site infections. In this study, maternal and perinatal outcomes of women with BMI &gt; 50&#xa0;kg/m² from a single center are presented.</p> Aims and Objectives <p>The primary objective was to determine the risk of maternal and fetal complications in super obese pregnant women. The secondary objective was to study the incidence of super obesity in the study population.</p> Methodology <p>This was a retrospective cohort study conducted over eleven years (January 2013–December 2023) at Fernandez Hospital, a tertiary perinatal care center with approximately 8000 births per annum. Data were sourced from electronic medical records. The study group included women with singleton pregnancies with BMI ≥ 50&#xa0;kg/m², birthed at the center and the control group included all other women.</p> Results <p>The overall incidence of super obesity (BMI ≥ 50&#xa0;kg/m²) was 1 in 1000 births. On comparing women with various BMI ranges, there was a significant increase in maternal complications such as chronic hypertension, pregnancy induced hypertension, pregestational diabetes mellitus, gestational diabetes mellitus and hypothyroidism (<i>p</i> &lt; 0.001) as the BMI increased. Super obese women experienced high rates of cesarean section (54%, <i>p</i> = 0.009), fetal growth abnormalities like small for gestational age (12%, <i>p</i> = 0.017), large for gestational age (17%, <i>p</i> &lt; 0.001) and stillbirths (1%, <i>p</i> = 0.001).</p> Conclusion <p>Adverse maternal and perinatal outcomes are directly proportional to maternal obesity. This emphasizes that these women should be managed at a dedicated clinic for comprehensive multidisciplinary care.</p>