Background: Climate exhibits substantial variation based on geographic location and latitude. Evidence of its effects on maternal health largely comes from temperate regions, while studies in tropical areas remain scarce, necessitating region-specific research to address these gaps effectively. This study assessed the association between climatic factors, such as temperature, precipitation, humidity, and solar radiation, and eclampsia and preeclampsia. Methods: This study used health insurance data from Indonesia's National Health Insurance registry, covering 342,432 pregnancies across 514 districts in 34 provinces from 2015 to 2022. Associations between climatic factors and pregnancy complications were analyzed using multilevel Poisson regression models, adjusting for individual and district characteristics. The relative risk (RR) and 95% confidence intervals (CI) were used to assess these relationships. Results: A 5 °C increase in temperature was associated with a decreased risk of pregnancy complications (RR = 0.86, 95% CI: 0.83–0.89), and a 100 mm increase in precipitation also lowered the risk (RR = 0.97, 95% CI: 0.95–0.98). Conversely, higher solar radiation (per 50 W/m2) and humidity (per 10 g/m3) were linked to an increased risk, with RRs of 1.02 (95% CI: 1.01–1.04) and 1.12 (95% CI: 1.05–1.19), respectively. Adjusting for district characteristics did not alter these relationships significantly. Conclusion: This study highlights the impact of climatic factors on the incidence of eclampsia and preeclampsia. A coordinated effort among multi stakeholders is crucial, with policymakers prioritizing the inclusion of localized climate variables in health programs, ensuring effective policy implementation, and preparing healthcare providers for climate-related challenges. © 2026 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.