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Background: Lower birth weight and preterm birth may increase the risk of adverse health outcomes later in life. We examined whether maternal exposure to air pollution and greenness during pregnancy is associated with offspring birth weight and preterm birth., Methods: We analyzed data on 4286 singleton births from 2358 mothers from Respiratory Health in Northern Europe, a prospective questionnaire-based cohort study (1990-2010). Mixed-effects regression models with random intercepts for mothers and centers were used to estimate the association of exposures to particulate matter (PM 2.5 and PM 10 ), nitrogen dioxide (NO 2 ), ozone (O 3 ), black carbon (BC), and greenness (Normalized Difference Vegetation Index in 300m-buffers [NDVI 300m ]) with birth outcomes, adjusting for potential confounders., Results: Median (interquartile range [IQR]) exposures to PM 2.5 , PM 10 , NO 2 , O 3 , BC, and NDVI 300m during pregnancy were 8.4(5.0) µg/m 3 , 14.4(8.3) µg/m 3 , 14.0(11.0) µg/m 3 , 54.7(10.2) µg/m 3 , 0.47(0.41) µg/m 3 , and 0.31(0.20), respectively. IQR increases in air pollution exposures during pregnancy were associated with decreased birth weight and the strongest association was seen for PM 2.5 (-49g; 95% confidence interval [CI] = -83, -16). However, O 3 showed an opposite association. IQR increase in NDVI 300m was associated with an increase in birth weight of 25 g (95% CI = 7, 44). Preterm birth was not associated with the exposures., Conclusion: Increased greenness and decreased air pollution may contribute to healthier pregnancies and improve overall health in the next generation. This emphasizes the need to adopt policies that target the reduction of air pollution emissions and exposure of the population., Competing Interests: The authors declare that they have no conflicts of interest with regards to the content of this report., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Environmental Epidemiology. All rights reserved.)