Early studies have investigated the effect of prenatal cadmium (Cd) exposure on birth outcomes, such as preterm birth and low birth weight, although the results of these studies are inconsistent. The aim of the present study was to investigate the association between prenatal exposure to Cd and the risk of preterm low birth weight (PLBW). A total of 408 mother-infant pairs (102 PLBW cases and 306 pair matched controls) were selected from the participants enrolled in the Healthy Baby Cohort (HBC) study between 2012 and 2014 in Hubei province, China. Concentrations of Cd in maternal urine collected before delivery were measured by inductively coupled plasma mass spectrometry and adjusted by creatinine. A significant association was observed between higher maternal urinary Cd levels and risk of PLBW (adjusted odds ratio (OR) = 1.75 for the medium tertile, 95% confidence interval (CI): 0.88, 3.47; adjusted OR = 2.51 for the highest tertile, 95% CI: 1.24, 5.07; P trend = 0.03). The association was more pronounced among female infants than male infants. Our study suggested that prenatal exposure to Cd at the current level encountered in China may potentially increase the risk of delivering PLBW infants, particularly for female infants.