Background. Zinc is an essential micronutrient that plays an important role in many biological functions. Zinc deficiency is common during pregnancy and has been linked with adverse pregnancy outcomes such as miscarriages, congenital malformations such as fetal neural tube defects, intrauterine growth restriction, pre-eclampsia, reduced birth weight, stillbirth, preterm or post-term deliveries, prolonged labour, postpartum haemorrhage, delayed behavioural development, delayed immune system development and increased mortality rate. Data on the prevalence of zinc deficiency among pregnant women and its association with adverse pregnancy outcome is scanty and inconclusive. Aim: The study was aimed to determine the prevalence of zinc deficiency and the association between maternal serum zinc levels during pregnancy and some adverse pregnancy outcomes such as primary postpartum haemorrhage, preterm birth, stillbirth and low birth weight neonates. Methods: This was a prospective cohort hospital-based study in which 200 pregnant women between 14 and 27 weeks gestational age were recruited at the antenatal clinics of LUTH. A structured proforma was used to collect data from consenting participant after which venous samples were collected according to the protocol described by the International Zinc Nutrition and Consultative Group (IZiNCG). Serum zinc analysis was done by flame automated atomic absorption spectrometry and zinc deficiency was defined as serum zinc levels less than 50 µg/dL. The associations between low maternal zinc concentrations and adverse pregnancy outcomes were examined using bivariate and multivariate analysis.