Background High-risk pregnancies are characterized by various factors that pose potential risks to maternal and newborn health outcomes. Early detection of these high-risk pregnancies serves as a crucial initial step in preventing maternal mortality and morbidity, thereby promoting the overall health of both mother and baby. This study sought to assess the occurrence of high-risk pregnancy and investigate the factors associated with it among pregnant women. Methods A descriptive survey was undertaken at the Obstetrics and Gynaecology outpatient department of a District Government Hospital in Tamil Nadu, involving 1889 pregnant women in their second and third trimesters. A structured questionnaire, constructed following the Indian standard criteria outlined by the National Health Portal of India, served as the data collection tool. The survey was conducted in February and March 2022, during which pregnant women were interviewed. Subsequently, the collected data underwent descriptive and inferential statistical analysis. Results Among the 1889 pregnant women surveyed, 29% (n=530) were classified as high-risk pregnancies. Within this group, 34.3% (n=182) were diagnosed with hypothyroidism, while 23.2% (n=123) experienced pregnancy-induced hypertension. Significant associations with high-risk pregnancy were observed for factors such as age, education status, occupation, family income, socioeconomic status, and gravida among the pregnant women. Conclusion Policymakers must urgently implement evidence-based interventions aimed at early detection and treatment of high-risk pregnancies. This proactive approach is essential in preventing maternal mortality and morbidity.