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The authors conducted a case-control study in Comunidad Valenciana, Spain, to assess the relation between occupational exposure to pesticides, mainly as a result of agricultural work, and the prevalence of congenital malformations. A total of 261 cases and 261 controls were selected from those infants born in eight public hospitals during 1993–1994. The cases were those who were diagnosed with selected defects (nervous system, cardiovascular, oral clefts, hypospadias/epispadias, musculoskeletal, and unspecified anomalies) during their first year of life. Information on occupational exposures and potential confounding variables was collected from the parents. For the mothers who were involved in agricultural activities during the month before conception and the first trimester of pregnancy, the adjusted odds ratio was 3.16 (95% confidence interval 1.11–9.01) primarily due to an increased risk for nervous …