Desert dust transported from the Sahara to the Caribbean generates peak exposures to particulate matter ≤ 10 μm (PM10). We investigated the impact of dust episodes on severe small for gestational-age births in Guadeloupe. The study sample consisted of 911 pregnant women enrolled in the Timoun mother-child cohort. Desert dust exposure was assessed through the mean daily PM10 concentrations averaged over the entire pregnancy. Numerous sociodemographic and medical risk factors were considered as covariates and introduced into multinomial logistic regression models. Odds ratios (ORs) were calculated per SD change (3.08 μg/m3). Among various outcomes, symmetrically growth-retarded births showed the highest OR (3.28, 95% CI: 1.08-10.02). Saharan dust seems to influence weight but not length or head circumference at birth. Given the high OR observed in this study, it is conceivable that Saharan dust plays a role through severe placental insufficiency early in pregnancy.