The literature shows associations between maternal exposures to PM 2.5 and adverse pregnancy outcomes. There are few data from Latin America. We have examined PM 2.5 and pregnancy outcomes in Lima. The study included 123,034 births from 2012 to 2016, at three public hospitals. We used estimated daily PM 2.5 from a newly created model developed using ground measurements, satellite data, and a chemical transport model. Exposure was assigned based on district of residence (n = 39). Linear and logistic regression analyzes were used to estimate the associations between air pollution exposure and pregnancy outcomes. Increased exposure to PM 2.5 during the entire pregnancy and in the first trimester was inversely associated with birth weight. We found a decrease of 8.13 g (−14.0; −1.84) overall and 18.6 g (−24.4, −12.8) in the first trimester, for an interquartile range (IQR) increase (9.2 µg/m 3) in PM 2.5. PM 2.5 exposure was positively associated with low birth weight at term (TLBW) during entire pregnancy (

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