Background Fish is an essential and traditional element in the diet of most Caribbean people. However it also contains methylmercury which can have severe effects on fetal neurodevelopment. The objective of this study was to assess the fish intake of a selected group of pregnant women from Jamaica and Trinidad & Tobago and evaluate prenatal mercury exposure, using the placenta as a biomarker. Method Food frequency questionnaires and placental samples were obtained from participating parturients at the time of delivery at the University Hospital of the West Indies in Kingston, Jamaica (N = 100, from November 2012 to March 2013) and the Mt Hope Women's hospital in St Joseph, Trinidad & Tobago (N = 30, in June 2015). The participants were asked to identify the species of fish and the frequency of consumption. Placental samples were analysed for mercury using cold vapour atomic absorption. Results The fish consumption preferences for pregnant women, varies based on the marine fish catch production of each country. The main fish species that contributed to the highest estimated methylmercury exposure in Jamaica and Trinidad & Tobago were cod and shark, respectively. There was a weak association between maternal fish intake and placental mercury concentrations. The mean placental mercury concentrations in Jamaica and Trinidad & Tobago were 0.74 ± 0.5 μg/kg and 1.46 ± 0.6 μg/kg, wet weight respectively. Conclusion The results from this study showed an influence of Caribbean fish intake preferences on mercury exposure and thus a recommendation for continuous bio-monitoring for public health purposes. [ABSTRACT FROM AUTHOR]