Desert dust transported from the Saharan-Sahel region to the Caribbean Sea is responsible for peak exposures of particulate matter (PM). This study explored the potential added value of satellite aerosol optical thickness (AOT) measurements, compared to the PM concentration at ground level, to retrospectively assess exposure during pregnancy. MAIAC MODIS AOT retrievals in blue band (AOT₄₇₀) were extracted for the French Guadeloupe archipelago. AOT₄₇₀ values and PM₁₀ concentrations were averaged over pregnancy for 906 women (2005–2008). Regression modeling was used to examine the AOT₄₇₀-PM₁₀ relationship during pregnancy and test the association between dust exposure estimates and preterm birth. Moderate agreement was shown between mean AOT₄₇₀ retrievals and PM₁₀ ground-based measurements during pregnancy (R² = 0.289). The magnitude of the association between desert dust exposure and preterm birth tended to be lower using the satellite method compared to the monitor method. The latter remains an acceptable trade-off between epidemiological relevance and exposure misclassification, in areas with few monitoring stations and complex topographical/meteorological conditions, such as tropical islands.