Urinary Tract Infections (UTIs) are common during pregnancy because hormonal, physiologic and mechanical changes cause vesico-ureteral reflux and urinary stasis which facilitate bacterial growth. The association between UTI during pregnancy and high risk for adverse maternal and neonatal outcomes are widely reported globally although findings are inconsistent. This study therefore determined the association between UTI during pregnancy and risk for adverse maternal and neonatal outcomes in a tertiary hospital in Cape Coast, Ghana. A case-control prospective study lasting six months was carried out with 220 pregnant women with UTI (cases) and 200 without UTI (control) attending the Antenatal Clinic of Central Regional Hospital, Cape Coast. Participants were assessed at each ANC visit and during labour for several outcomes. Data were analyzed on SPSS 16. The study showed statistically significant associations between maternal UTI and adverse outcomes including foul-smelling liquor (p=0.006); premature rupture of membrane (p<0.001); intra-partum bleeding (APH and PPH; p<0.001). Neonatal outcomes included low birth weight (p=0.014), preterm delivery (p<0.001); Apgar score at 1 minute (p<0.001); stillbirth (p=0.022). Associations were not significant between maternal UTI and pregnancy-induced hypertension and baby’s Apgar score at 5 minutes. We conclude that UTI in pregnancy adversely affects the mother and the neonate.