Background: Despite the fact that Chlamydia trachomatis (CT) infection in pregnancy is known to have grave impact on maternal and neonatal health, routine CT screening in pregnancy is not available in Ghana The main aim of this study was to determine the prevalence and adverse maternal outcomes of CT infection among pregnant women attending antennal clinic at the Cape Coast Teaching Hospital. Methods: Two hundred and thirty two (232) pregnant women screened for CT infection by PCR were purposively selected and enrolled into the study after informed consent had been obtained. They included one hundred and twelve (112) participants with positive CT (cases) and 120 participants without CT infections (control). A structured questionnaire was used to collect their socio demographic, obstetric and medical history. They were monitored thereafter and data on maternal outcomes were collected. Results: The prevalence of CT infection was 5.6% (112/2014). A history of STI/UTI (p<0.001) spontaneous abortion (p=0.02), preterm labour (p<0.001) and intrapartum or postpartum fever (p<0.001) were found to be associated with CT infection. However a history of Stillbirth, PID and having been treated for infertility were not associated with CT infection. Participants with CT infection were more likely to have PROM (p<0.001) and FSL (p<0.001) than those who were not infected. Parity and mode of delivery on the other hand were not associated with CT infection. Conclusions: To alleviate the adverse maternal outcomes, screening for CT infection in pregnancy should be offered routinely to pregnant women to promote early detection and treatment.