Background Evidence of fetal damage or demise from occupational organic solvent levels that are not toxic to the pregnant woman is inconsistent in the medical literature. The risk for major malformations and spontaneous abortion from maternal inhalation of organic solvent exposure during pregnancy was summarized using meta‐analysis. Methods Medline, Toxline, and Dissertation Abstracts databases were searched to locate all research papers published in any language from 1966 to 1994. Included were studies that were case‐control or cohort in design and indicated first trimester (or up to 20 weeks gestation for spontaneous abortion) maternal solvent exposure. A summary odds ratio (ORs) with 95% confidence intervals (CI) was calculated from research results combined by the Mantel‐Haenszel method. Results In total, 559 studies were obtained from the literature search. Five studies for each outcome of interest qualified for inclusion in the analysis. The ORs for major malformations from five studies (n = 7,036 patients) was 1.64 (CI 1.16–2.30) and for spontaneous abortion from five studies (n = 2,899 patients) was 1.25 (CI 0.99–1.58). Conclusions Maternal occupational exposure to organic solvents is associated with a tendency toward an increased risk for spontaneous abortion and additional studies may affect the trend. There is a statistically significant association with major malformations which warrants further investigation. Am. J. Ind. Med. 34:288–292, 1998. © 1998 Wiley‐Liss, Inc.