Background: Subclinical hypothyroidism during pregnancy, though often asymptomatic, has been associated with a range of maternal and fetal complications in various studies. The purpose of this study is to assess the impact of subclinical hypothyroidism on pregnancy complications in a tertiary care hospital setting. Aim of the study: The aim of the study was to evaluate the impact of subclinical hypothyroidism on pregnancy complications in a tertiary care hospital setting. Methods: This case-control study was conducted from September 2015 to February 2016 at the Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Fifty pregnant women (25 subclinical hypothyroid, 25 euthyroid) were enrolled based on set criteria. Data on demographics, clinical history, and thyroid function were collected and participants were followed through pregnancy to assess maternal and neonatal outcomes. Data were analyzed with SPSS v20. Results: Among 50 pregnant women, subclinical hypothyroidism cases were older (29.16±6.45 vs. 26.16±4.85 years) with lower socioeconomic status (p=0.035). Obstetric (preeclampsia 24% vs. 4%) and medical complications (GDM 32% vs. 12%) were more frequent but not significant. Cases showed more anemia (48% vs. 44%), oedema (28% vs. 8%), and hypertension (28% vs. 16%). Fetal outcomes included 4% intrauterine death in cases. Low Apgar scores, low birth weight (36% vs. 20%), and neonatal complications like asphyxia (36% vs.16%) were higher in cases, without significant differences. Conclusion: Subclinical hypothyroidism in pregnancy is associated with increased risks of maternal and fetal complications, underscoring the importance of vigilant monitoring.