Purpose: To evaluate the prevalence of gestational diabetes mellitus (GDM) and analyze associated fetomaternal outcomes among pregnant women who received antenatal care and delivered at Saraswati Medical College between 2017 and 2019. Methods: This retrospective observational study analyzed antenatal records and delivery outcomes of 1,260 women over a three-year period. Data were collected on maternal demographics, gestational age at diagnosis, antenatal complications, mode of delivery, and neonatal outcomes. GDM was diagnosed using IADPSG criteria following oral glucose tolerance testing. Results: The prevalence of GDM was 11.2%. Women diagnosed with GDM were significantly more likely to undergo cesarean section (58.2% vs 38.6%, p<0.001) and experience antenatal complications such as polyhydramnios (15.8%) and hypertensive disorders (12.1%). Neonatal complications included macrosomia (9.7%), hypoglycemia (6.9%), and NICU admissions (17.2%)—all significantly higher than in the non-GDM cohort. Conclusion: GDM is a prevalent and clinically significant condition in this population, associated with adverse fetomaternal outcomes. Early diagnosis and multidisciplinary management are essential to optimize maternal and neonatal health.