Objectives To compare the Asian Indian body mass index (BMI) and waist circumference (WC) with World Health Organization (WHO) BMI and WC in the prediction of adverse maternal and perinatal outcome in overweight and obese women. Materials and Methods Prospective analysis of 239 women booked within 10 weeks of pregnancy and followed till delivery at our centre was performed. Results The mean age of the study group was 26.08 years, of which elderly gravida was 1.3 %. Overall, 17.6 % were overweight, 29.7 % were obese, and 42.7 % had abdominal obesity as per Asian Indian BMI and WC cutoff, whereas only 8.5 % were obese, and 14.2 % had abdominal obesity as per WHO. In high-risk group, gestational diabetes was commonest complication (20 %). Compared to WHO, Asian Indian BMI cutoff has statistically significant predictability for gestational diabetes, preeclampsia and its complications, labour induction, and Caesarean section rate. On the other hand, Asian WC has the best predictability only for preeclampsia and its complications. Sensitivity, specificity, and negative predictive