AbstractThis study examined the association between exposure to occupational hazards and pregnancy outcomes using data from a case‐control study conducted in 29 hospitals in Shanghai, China. The sample included 1,875 perinatal deaths and newborns with birth defects and the same number of controls. Information on mother's exposure to occupational radiation, chemicals, noise, and pesticides was investigated. Logistic regression analysis controlling for potential confounders showed that exposure to radiation before/during pregnancy was associated with antepartum fetal death, birth defects, small‐for‐gestational‐age (SGA), and threatened abortion. Exposure to chemicals before/during pregnancy was associated with antepartum fetal death, early neonatal death, birth defects, preterm birth, and threatened abortion. Women exposed to pesticides during pregnancy had an increased risk of SGA and threatened abortion. Exposure to occupational noise during pregnancy increased the risk of antepartum fetal death. Furthermore, higher than expected numbers of congenital anomalies in the central nervous system (CNS) were identified among women exposed to chemicals before pregnancy and to pesticides during the first trimester of pregnancy. No significant association was found between occupational exposure and intrapartum fetal death. Although recall bias may be possible in our study, the findings encourage further research.