Flight attendants have been reported to be at increased risk for menstrual abnormalities and for spontaneous fetal loss. This study examined Washington State birth certificates for associations between adverse pregnancy outcomes and maternal employment as a flight attendant. Current pregnancy outcomes (low birthweight, prematurity, low Apgar scores, and abnormal sex ratio) were not significantly related to occupation. Flight attendants reported their preceding pregnancy resulted in a spontaneous fetal loss nearly twice as often as other women (relative risk = 1.9, 95% confidence interval = 1.3-2.7). However, when comparison was restricted to other employed women, the risk was lower (RR = 1.3, 95% CI = 0.9-1.9). A clinically significant pregnancy risk among flight attendants cannot be excluded on the basis of this study, but the apparent excess risk of spontaneous fetal loss in this and particularly in a previous study could be explained at least in part by methodologic limitations.