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Objectives: To describe the degree of annoyance caused by air pollution and noise in pregnant women in a birth cohort; to determine the modifying factors and their relation with exposure to ambient nitrogen dioxide (NO,). Methods: The study population was 855 pregnant women in Valencia, Spain. Annoyance caused by air pollution and noise, and explanatory factors were obtained from 786 pregnant women through a questionnaire. NO2 levels were determined combining measurements at 93 points within the area of study and using geostatistical techniques (kriging). Results: In all 7.9% of the women reported high annoyance caused by air pollution and 13.1% high annoyance caused by noise. There was a significant difference in the degree of annoyance due to both air pollution and noise depending on the area where the women lived and their working status. The degree of annoyance correlated better with measured NO, at the municipality level (air pollution: r = 0.53; noise: r = 0.44) than at the individual level (air pollution and noise: r = 0.21). On multivariate analysis, being a housewife, higher NO2 levels and high traffic density were associated with higher degrees of annoyance. Conclusions: There was a high percentage of women who perceived medium-high annoyance due to noise and air pollution. Annoyance caused by environmental pollutants could lead to some psychological effects, which impair the quality of life, or even physiological ones, which affect prenatal development. (C) 2007 Elsevier Ltd. All rights reserved.