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(1) Background: Arsenic (As) is a common drinking water contaminant that is regulated as a carcinogen. Yet, As is a systemic toxicant and there is considerable epidemiological data showing As adversely impacts reproductive health. This study used data from a birth cohort in Bangladesh (2008–2011) to examine associations between drinking water As levels and reproductive outcomes. (2) Methods: Pregnant individuals (<i>n</i> = 1597) were enrolled at <16 weeks gestation and drinking water As was measured. Participants with live births (<i>n</i> = 1130) were propensity score matched to participants who experienced miscarriage (<i>n</i> = 132), stillbirth (<i>n</i> = 72), preterm birth (<i>n</i> = 243), and neonatal mortality (<i>n</i> = 20). Logistic regression was used to examine drinking water As recommendations of 50, 10, 5, 2.5, and 1 µg/L on the odds of adverse birth outcomes. (3) Results: The odds of miscarriage were higher for pregnant women exposed to drinking water ≥2.5 versus <2.5 µg As/L [adjusted odds ratio (OR) 1.90, 95% Confidence Interval (CI): 1.07–3.38)]. (4) Conclusions: These preliminary findings suggest a potential threshold where the odds of miscarriage increases when drinking water As is above 2.5 µg/L. This concentration is below the World Health Organizations and Bangladesh’s drinking water recommendations and supports the re-evaluation of drinking water regulations.