Antenatal care (ANC) has been shown to influence infant and maternal outcomes. WHO recommends 4 ANC visits for uncomplicated pregnancies. However, pregnant women in Ghana are required to attend 8-13 antenatal visits. We investigated the association of ANC attendance with adverse pregnancy outcomes (defined as low infant birth weight, stillbirth, preterm delivery or small for gestational age). A quantitative crosssectional study was conducted on 629 women, age 19-48 years who presented for delivery at two selected public hospitals and 16 traditional birth attendants from July to November 2011. Socio-demographic and antenatal information were collected using a structured questionnaire. ANC attendance, medical and obstetric/gynecological history were abstracted from maternal antenatal records. Data were analyzed using Chi square and logistic regression. Twenty-two percent of the women experienced an adverse outcome. Eleven percent of the women attended <4 ANC visits. In an unadjusted model, these women had an increased likelihood of experiencing an adverse outcome (OR 2.27; 95 % CI 1.30-3.94; p = 0.0038). High parity (>5 children) was also associated with adverse birth outcomes. Women screened for syphilis or use of insecticide- treated bed nets had a 40 and 36 % (p = 0.0447 and p = 0.0293) reduced likelihood of experiencing an adverse pregnancy outcome respectively. After adjusting for confounders, attending<4 antenatal visits was associated with adverse pregnancy outcome compared with ≥4 ANC visits (Adjusted OR 2.55; 95 % CI 1.16-5.63; p = 0.0202). Attending <4 antenatal visits and high parity were associated with adverse pregnancy outcomes for uncomplicated pregnancies. © Springer Science+Business Media New York 2013.