<![CDATA[Background: Preterm birth remains one of the leading causes of neonatal morbidity and mortality worldwide. Maternal smoking and secondhand smoke exposure during pregnancy are modifiable risk factors associated with adverse pregnancy outcomes. Objective: This study aimed to analyze the association between maternal smoking habits, secondhand smoke exposure, and preterm birth at Haji Adam Malik General Hospital, Medan. Methods: A retrospective case-control study was conducted using medical record data. A total of 52 mothers were selected through purposive sampling, consisting of 26 mothers with preterm birth and 26 mothers with term birth. Data were collected using a structured checklist and analyzed using the Chi-square test with a significance level of p<0.05. Results: Maternal smoking was significantly associated with preterm birth (p=0.011; OR=4.545; 95% CI: 1.370–15.077). Secondhand smoke exposure was also significantly associated with preterm birth (p=0.012; OR=4.343; 95% CI: 1.344–14.038). Conclusion: Maternal smoking and secondhand smoke exposure significantly increased the risk of preterm birth. Strengthening smoking cessation programs, promoting smoke-free home environments, and incorporating routine screening and counseling during antenatal care are recommended to reduce tobacco smoke exposure and prevent preterm birth. Keywords: maternal smoking, secondhand smoke, preterm birth, pregnancy, risk factors]]>
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