Background <p>Leptospirosis is one of the most prevalent zoonoses worldwide. Its presentation is varied in severity and non-specific mimicking other infectious diseases and pregnancy conditions such as HELLP or AFLP.</p> Aims and Objectives <p>This study aims to evaluate the maternal and foetal outcomes of leptospirosis and estimate its prevalence in pregnancy at a tertiary care centre.</p> Methods <p>This is an observational descriptive study conducted at a tertiary care teaching hospital in Western India over a duration of 5&#xa0;years. All pregnant patients diagnosed as leptospirosis via IgM ELISA were included.</p> Results <p>A total of 37 patients were enrolled. Majority presented in the first trimester and belonged to the low socio-economic strata. Fever was the most persistent symptom. Five patients had a spontaneous abortion, two underwent MTP, eight had a preterm delivery, whereas 22 patients carried up till term (of which 18 delivered vaginally and four underwent a LSCS). Majority had leucocytosis and were anaemic. Twelve cases had hyperbilirubinaemia, six had deranged transaminases, three had raised serum creatinine values and two had thrombocytopenia. Four patients required management in the ICU out of which two progressed to Weil’s disease and one succumbed to death. The research team at our centre yielded an estimated 9.06% prevalence of leptospirosis.</p> Conclusion <p>Leptospirosis is often underdiagnosed and hence under-reported. Being a re-emerging infectious disease, an early clinical suspicion and sound understanding of the disease process in pregnant women is required.</p>