Objectives <p>Adolescent pregnancy is an important public health issue in low and middle- income countries. They are vulnerable to pregnancy- related complications with adverse fetal outcomes because of their immature and developing reproductive systems.</p> Study design <p>This study is a systematic review of peer-reviewed articles focused on maternal and foetal complications related to adolescent pregnancy in India. The review adhered to the PRISMA 2020 guidelines throughout the process.</p> Methods <p>A comprehensive search of peer-reviewed articles was conducted using PubMed, CINAHL Plus, Scopus, Web of Science, Ovid-Embase, and Medline. Articles were screened based on predefined inclusion and exclusion criteria. Following critical appraisal, thirteen studies were included in the review.</p> Results <p>The findings reveal a higher incidence of anaemia, hypertensive disorders of pregnancy, preterm delivery, low babies, and NICU admissions among adolescent mothers. The incidence of adolescent pregnancies in India ranges from 6% to 18.3%. Among adolescent pregnancies, the elevated rates of preterm delivery and low birth weight were associated with increased incidence of foetal distress and NICU admission, underscoring the heightened clinical vulnerability of this population.</p> Conclusions <p>The review concludes that adolescent pregnancy in India has significant negative health impacts on both mothers and babies. Preventative measures should be comprehensive and multi-faceted, including stringent enforcement of legal measures to prevent child marriage, raising awareness among adolescents and communities about pregnancy-related complications, and providing comprehensive, age-appropriate sexuality education.</p>