Introduction: Tobacco use is one of the main reason of mortality and morbidity all over the globe. Smokeless tobacco (SLT) use is increasing day by day in our country especially in uneducated women of poor socio economic families. Smokeless tobacco (SLT) is used in the form of Gutka, betel quid, chalia, naswar etc. according to a survey 4.6% smokeless users were females. Gutka is a combination of tobacco, areca nuts, and various kinds of chemicals and flavors. The adverse effects of smokeless tobacco are known as it can cause oral and gums problems like carcinoma of gums etc. Its effects on fetus are also being studied and is evidenced that it may cause adverse birth outcomes like low birth weight babies, preterm deliveries and also anemia and folate deficiency in mothers. Objective: To evaluate the impact of Gutka consumption on maternal birth outcomes in tertiary care hospital.  Methods: An observational cross sectional study was conducted at Jam Ghulam Qadir Hospital Hub Chowki, Balochistan. When pregnant women came to hospital for delivery, self-administered questionnaire was given. We included 250 women who were using gutka and 250 women who were not using gutka. After delivery we recorded birth outcomes. Sample was divided into 2 groups A consisted pregnant woman who used Gutka and B group comprised of pregnant women who did not consumed Gutka. Then these two groups were compared. Results: The results of this study demonstrated a very high degree of females using Gutka and leading to adverse maternal and fetal outcomes. Conclusions: It is evident that higher usage of Gutka led to a significant decrease in infantile mean birth weight, length, head circumference of infant at birth, gestational length, physical condition of neonate, APGAR scores and any other abnormality such as cleft palate and lip in comparison to Non-Gutka users.