This paper investigates the impact of timeline-bound fetal exposure to drought shocks on birth outcomes in rural Sierra Leone. We link repeated cross-section birth record data across 11 years from the Sierra Leone Demographic and Health Surveys to district-level geolocation precipitation data from the University of Delaware weather repository. The methodology uses spatial distribution of precipitation across districts to identify the impacts of extreme droughts on birth outcomes. This study reinforces both harvest and direct gestation as maternal nutrition pathways for the impact of drought shocks on birth outcomes. Results also show that adverse in utero shock impacts are concentrated among poorer households and may be mitigated by antenatal care services.