Air pollution and the various chemicals that are a part of this complex mixture have been associated with several adverse infant health outcomes. One major area of research is describing the underlying biological mechanism between air pollution and adverse infant health outcomes. Metabolomics, a new omics field, studies small molecules present in a biological matrix and may provide insight into underlying biological mechanism. We conducted a narrative review of the literature to identify studies utilizing metabolomics with air pollution, or some potential component of it, and adverse infant health. We identified seven studies that met our inclusion criteria. These studies described a range of potential air pollutants including tobacco smoke, PAH, NO2, PM2.5, O3, BC, heavy metals, and PFAS. The studies mainly focused on gestational age and weight outcomes. Metabolic analysis revealed many altered metabolomic pathways including those related to amino acid metabolism, glycan metabolism, lipid metabolism, and cofactor and vitamin metabolism. These studies provide valuable insight into the potential biological mechanisms that underpin the association between air pollution and adverse gestational outcomes. Future studies should utilize longitudinal study design and use complex mixture analysis for air pollution exposure assessment, as well as focus on the use of more toxicologically relevant target tissue for infant health outcomes.