evidence: In India, the high prevalence of high-risk pregnancies is a matter of concern, and it could be a probable factor for high maternal and neonatal morbidity and mortality in the country. The Northeastern states such as Meghalaya, Manipur and Mizoram exhibit the highest frequency of high-risk pregnancies. Further investigations are required focusing on factors such as advanced maternal age, tobacco use, pre-existing diseases, and adverse birth outcome issues. Short birth spacing contributes to the major share to HRP prevalence in India. Appropriate measures on birth spacing issues through policy and programmes and creating public awareness and education of women in the long run will help for further improvement of maternal and neonatal outcomes. The government should focus on regional-specific health issues and regional policies on socio-behavioural interventions to improve lifestyle practices, particularly in the Northeast. States with a lower prevalence of HRP witnessed higher maternal deaths in Odisha, Chhattisgarh and Assam, suggesting that need of more clinical and laboratory investigations could be the best possible way to address the health issues and also to improve the maternal health and outcomes.