Quantum Machine Learning (QML) integrates quantum computing with classical machine learning, primarily to solve classification, regression, and generative tasks. However, its rapid development raises critical security challenges in the Noisy Intermediate-Scale Quantum (NISQ) era. This chapter examines adversarial threats unique to QML systems, focusing on vulnerabilities in cloud-based deployments, hybrid architectures, and quantum generative models. Key attack vectors include model stealing via transpilation or output extraction, data poisoning through quantum-specific perturbations, reverse engineering of proprietary variational quantum circuits, and backdoor attacks. Adversaries exploit noise-prone quantum hardware and insufficiently secured QML-as-a-Service (QMLaaS) workflows to compromise model integrity, ownership, and functionality. Defense mechanisms leverage quantum properties to counter these threats. Noise signatures from training hardware act as non-invasive watermarks, while hardware-aware obfuscation techniques and ensemble strategies disrupt cloning attempts. Emerging solutions also adapt classical adversarial training and differential privacy to quantum settings, addressing vulnerabilities in quantum neural networks and generative architectures. However, securing QML requires addressing open challenges such as balancing noise levels for reliability and security, mitigating cross-platform attacks, and developing quantum-classical trust frameworks. This chapter summarizes recent advances in attacks and defenses, offering a roadmap for researchers and practitioners to build robust, trustworthy QML systems resilient to evolving adversarial landscapes.