Background: Chronic exposure to arsenic through drinking water has the potential to cause adverse pregnancy outcomes, although the association has not been demonstrated conclusively. This cross-sectional study assessed the association between arsenic in drinking water and spontaneous abortion, stillbirth, and neonatal death. Methods: In this cross-sectional study, 533 women were interviewed. Information on sociodemographic characteristics, drinking water use, and adverse pregnancy outcomes was obtained through a structured pretested interviewer-administered questionnaire. The respondents reported use of a total of 223 tube wells; for 208 wells, water samples were measured using an ultraviolet/visible spectrophotometry method, whereas 15 were measured by flow-injection hydride generation atomic absorption spectrometry (FIHG-AAS). Results: Excess risks for spontaneous abortion and stillbirth were observed among the participants chronically exposed to higher concentrations of arsenic in drinking water after adjusting for participant's height, history of hypertension and diabetes, and (for neonatal death only) age at first pregnancy. Comparing exposure to arsenic concentration of greater than 50 mug/L with 50 mug/L or less, the odds ratios were 2.5 (95% confidence interval = 1.5-4.3) for spontaneous abortion, 2.5 (1.3-4.9) for stillbirth, and 1.8 (0.9-3.6) for neonatal death. Conclusions: These study findings suggest that chronic arsenic exposure may increase the risk of fetal and infant death.