Background <p>Acute pancreatitis during pregnancy is a rare but potentially severe condition that may adversely affect both maternal and fetal outcomes. Although advances in intensive care have improved prognosis, the impact of the disease on pregnancy outcomes remains an important clinical concern.</p> Aims <p>This study aimed to investigate maternal and fetal outcomes in pregnancies complicated by acute pancreatitis and to evaluate the effect of disease severity on these outcomes.</p> Methods <p>This retrospective study was conducted at a tertiary care center and included 25 pregnant women diagnosed with acute pancreatitis and 100 healthy controls between February 2020 and February 2025. Maternal and fetal outcomes were first compared between the acute pancreatitis and control groups. Subsequently, patients with acute pancreatitis were classified into mild and severe subgroups according to disease severity, and subgroup analyses were performed. Clinical, laboratory, and obstetric outcomes were analyzed using appropriate statistical methods.</p> Results <p>Patients with acute pancreatitis had significantly longer hospital stays and higher rates of maternal intensive care unit admission compared with controls (p &lt; 0.001 for both). Gestational age at delivery was lower and neonatal birth weights were reduced in the acute pancreatitis group (p &lt; 0.001 and p = 0.004, respectively). Neonatal mortality was also higher in this group (p &lt; 0.001). In subgroup analyses, patients with severe acute pancreatitis had higher maternal ICU admission rates (p = 0.001), longer ICU stays (p = 0.005), and increased neonatal ICU admissions (p = 0.022).</p> Conclusions <p>Acute pancreatitis during pregnancy is associated with adverse maternal, fetal, and neonatal outcomes, particularly in severe cases. Early recognition and close multidisciplinary management in tertiary centers may help reduce complications and improve pregnancy outcomes.</p>