Aim: The aim of this study was to assess maternal and perinatal outcomes in preterm labor associated with asymptomatic bacteriuria (ASB) and to evaluate the impact of ASB on neonatal health and maternal complications across different gestational ages. Materials and Methods: This prospective observational study included 100 pregnant women aged 18-40 years, presenting with preterm labor between 28 and 36 weeks of gestation, and diagnosed with ASB. Urine samples were collected, and positive cultures were followed by sensitivity testing for antibiotic treatment. Maternal outcomes, including progression of labor and complications, and perinatal outcomes, such as birth weight, Apgar scores, neonatal sepsis, and NICU admissions, were monitored. Results: Birth weight increased significantly with advancing gestational age, ranging from 1.80 kg (28-30 weeks) to 2.60 kg (34-36 weeks) (P=0.001). NICU admissions were highest among neonates born at 28-30 weeks (85%) and lowest at 34-36 weeks (35%) (P=0.003). Apgar scores at 1 minute improved with gestational age, from 5.2 (28-30 weeks) to 7.6 (34-36 weeks) (P=0.015). Maternal complications were more frequent in earlier gestational ages, with 40% in the 28-30 week group compared to 10% in the 34-36 week group (P=0.022). Neonatal sepsis was observed in 15% of neonates at 28-30 weeks, decreasing to 5% at 34-36 weeks (P=0.035). Conclusion: The study demonstrates that ASB in preterm labor is associated with adverse maternal and perinatal outcomes, including higher rates of maternal complications, NICU admissions, and neonatal sepsis. Early detection and treatment of ASB are critical to improving outcomes in preterm births.