OBJECTIVE To evaluate the rate and causes of preterm (before 37 weeks gestation) and very preterm (before 32 weeks gestation) delivery among a population of Inuit living in Canada. METHODS Three-year retrospective cross-sectional review of charts for patients delivering in the Baffin Region of Canada. RESULTS There were 938 births over the study period; 95% to Inuit women. Inuit women had a preterm delivery rate of 18.2% and a very preterm delivery rate of 2.4%, more than twice the Canadian national average. Sociodemographic risk factors for preterm delivery including substance use, young age, single marital status, and poor nutrition, occurred more frequently among Inuit women compared to non-Inuit women, but were not independently associated with prematurity. Known medical and obstetrical risk factors were associated with preterm delivery among Inuit women; history of prior preterm delivery, multiple pregnancy, placenta previa, poor weight gain and vaginal bleeding after 20 weeks gestation. Hospitalization rates and infant mortality were higher among preterm infants. The most common indication for hospitalization was respiratory infection (51.1%) followed by other infection (15.8%). CONCLUSIONS Inuit women had preterm and very preterm delivery rates more than twice the Canadian national average. Preterm delivery was associated with several medical risk factors and resulted in significant increases in infant hospitalization and mortality.