Background: Urinary tract infection (UTI) is one of the most prevalent bacterial infections during pregnancy, associated with significant maternal and fetal morbidity if left untreated. The physiological changes of pregnancy, such as urinary stasis and altered urine composition, increase the risk of both symptomatic and asymptomatic UTIs. Early identification and management are therefore crucial. Aim of the study: To evaluate the incidence of urinary tract infections during pregnancy and assess the associated maternal and fetal outcomes in a tertiary care setting. Methods: This prospective study was conducted over two years in the Department of obstetrics and Gynecology, Rangpur Community Medical College Hospital, Rangpur, Bangladesh. A total of 220 pregnant women aged 18–40 years were enrolled, of whom 41 were diagnosed with UTI based on clinical presentation, urine microscopy, and culture sensitivity. Patients were classified as having symptomatic or asymptomatic UTI and were followed throughout pregnancy and postpartum for adverse outcomes. Statistical analysis was performed using SPSS version 26. Result: Among the 41 UTI-positive cases, the highest incidence (60.98%) was observed in women aged 18–25 years and in primigravida patients (56.10%). The majority (58.54%) of infections occurred during the second trimester. Asymptomatic UTI accounted for 65.25% of cases. The most common pathogen was Escherichia coli (36.59%), followed by Klebsiella (24.39%). Adverse maternal outcomes included anemia (26.83%), puerperal pyrexia (24.39%), and abortion (12.20%). Fetal complications included preterm birth (36.59%), fetal growth restriction (14.63%), and perinatal mortality (12.20%). Conclusion: UTI during pregnancy is a frequent and often silent infection, with significant implications for both maternal and fetal health. Routine screening and prompt treatment are essential, especially during the second trimester, to minimize complications such as preterm labor, intrauterine growth restriction, and perinatal mortality.