Since the advent of DDT as an insecticide in the late 1930s, billions of kilograms of pesticide active ingredient have been sold in North America and around the world. In recent years, there has been a heightened public awareness of pesticides and child health and a number of epidemiologic studies linked pre- and postnatal exposures to pesticides to a number of adverse developmental outcomes, including fetal death, intrauterine growth restriction, preterm birth, and birth defects. Given this, it was felt prudent to critically appraise the evidence for periconceptual pesticide exposures and developmental outcomes. The epidemiological evidence for specific pesticide classes, families, and active ingredients were examined and summarized and recommendations were made for how to improve future studies in order to address the current pitfalls and gaps in the studies in this area. Many of the studies suffered from poor exposure estimation, relying on job title only and/or the exposure category "any pesticide" as a measure of exposure, and there was limited or inadequate evidence to support causality for all associations examined.