Background: Adverse pregnancy outcomes is a broad term comprising health problems that occur to the mother, the newborn, or both during pregnancy, labor, delivery and the postpartum period. Despite ongoing efforts to improve maternal health, there is paucity of data from the study area on the specific factors contributing to adverse pregnancy outcomes. The main aim of this study was to determine the prevalence and factors associated with adverse pregnancy outcomes at the Buea Regional Hospital. Methods: This retrospective study was carried out at Buea Regional Hospital. A total of 1069 Files of women admitted to the maternity wards from January 1st 2022 to December 31st 2024 were reviewed. Data analysis was performed using the Statistical Package for Social Sciences version 28. Statistical associations were set at p values <0.05. Results: The overall prevalence of adverse pregnancy outcomes was found to be 24.3% with preterm delivery (27.5%) and preeclampsia (22.7%) being the most common. Maternal level of education, employment status, body mass index, smoking, alcohol consumption, multiple gestation, and cesarian delivery were found to be significant predictors of adverse pregnancy outcomes with p values of 0.020, 0.043, 0.013, 0.016, 0.002, 0.011 and 0.003 respectively. Conclusion: Health institutions and community stakeholders should strengthen maternal health education programs focused on early antenatal booking, nutrition, lifestyle modification, and danger sign recognition to reduce the prevalence of adverse pregnancy outcomes