This study examined risk factors that contribute to antepartum fetal death. The population-based sample included 416 antepartum fetal deaths and 449 normal births as controls, from 29 hospitals in Shanghai, China. In addition to small-for-gestational-age and severe pregnancy-induced hypertension, exposure to environmental hazards (radiation, chemicals and pesticides) was significantly associated with fetal death. Elevated relative risk of fetal death was also found in pregnant women whose husbands smoked (adjusted odds ratio = 1.4). Clinicopathologic evidence further confirmed that exposure to hazards, especially in the first trimester, increased the risks of congenital anomalies (odds ratio = 2.7) and antepartum fetal death from congenital malformations (odds ratio = 3.5). This study also showed that threatened abortion was a significant predictor of risk of fetal death. No significant relationships were identified between sex of fetus, mild or moderate pregnancy-induced hypertension, maternal anemia and antepartum fetal death.