In utero exposures to environmental contaminants can occur through maternal-placental transfer. High level maternal exposures to environmental pollutants, such as lead, mercury, cadmium, DDT and polycyclic aromatic hydrocarbons smoke have been associated with congenital anomalies, severe developmental and cognitive impairment, and growth retardation in offspring. Evidence shows that fetuses and infants are more affected than adults by a variety of environmental pollutants because of differential exposure, physiologic immaturity and a longer lifetime over which diseases initiated in early life can develop. Our previous studies have shown that Saudi population, like other countries, is susceptible to environmental pollutants in spite of the difference in the sources of exposure. Moreover, there have been a number of hospital-based studies in different cities in Saudi Arabia reporting the high prevalence of birth defects, infant mortality and congenital malformations with regional variations in the pattern. This article reviews current knowledge on the potential links between environmental pollutants and the pregnancy outcome with an attempt to throw the light on available studies in Saudi Arabia.