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Objective Pregnancy and the obesity epidemic impacting women of reproductive age appear to predispose women to obstructive sleep apnea (OSA) in pregnancy. The aim of this study is to examine the association between OSA and adverse maternal outcomes in a national cohort. Methods The National Perinatal Information Center in the US was used to identify women with a delivery discharge diagnosis of OSA from 2010 to 2014. We used the International Classification of Diseases, 9th Revision to classify OSA diagnosis and maternal outcomes. Results The sample consisted of 1,577,632 gravidas with a rate of OSA of 0.12% (N=1963). There was a significant association between OSA and preeclampsia (adjusted odds ratio (aOR) 2.22, 95% confidence interval (CI) 1.94–2.54), eclampsia (aOR 2.95, 1.08–8.02) and gestational diabetes (aOR 1.51, 1.34–1.72) after adjusting for a comprehensive list of covariates which includes maternal obesity. OSA status was also associated with a 2.5- to 3.5-fold increase in risk of severe complications such as cardiomyopathy, congestive heart failure and hysterectomy. Length of hospital stay was significantly longer (5.1 ± 5.6 vs 3.0 ± 3.0 days, p<0.001) and odds of an admission to an intensive care unit higher (aOR 2.74, 2.36–3.18) in women with OSA. Conclusions Compared to pregnant women without OSA, pregnant women with OSA have a significantly higher risk of pregnancy-specific complications such as gestational hypertensive conditions and gestational diabetes, and rare medical and surgical complications such as cardiomyopathy, pulmonary edema, congestive heart failure and hysterectomy. OSA diagnosis was also associated with a longer hospital stay and significantly increased odds for admission to the intensive care unit.