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There are few data from Latin America. We have examined PM<jats:sub>2.5<\/jats:sub> and pregnancy outcomes in Lima. The study included 123,034 births from 2012 to 2016, at three public hospitals. We used estimated daily PM<jats:sub>2.5<\/jats:sub> from a newly created model developed using ground measurements, satellite data, and a chemical transport model. Exposure was assigned based on district of residence (<jats:italic>n<\/jats:italic>\u2009=\u200939). Linear and logistic regression analyzes were used to estimate the associations between air pollution exposure and pregnancy outcomes. Increased exposure to PM<jats:sub>2.5<\/jats:sub> during the entire pregnancy and in the first trimester was inversely associated with birth weight. We found a decrease of 8.13\u2009g (\u221214.0; \u22121.84) overall and 18.6\u2009g (\u221224.4, \u221212.8) in the first trimester, for an interquartile range (IQR) increase (9.2\u2009\u00b5g\/m<jats:sup>3<\/jats:sup>) in PM<jats:sub>2.5<\/jats:sub>. PM<jats:sub>2.5<\/jats:sub> exposure was positively associated with low birth weight at term (TLBW) during entire pregnancy (OR: 1.11; 95% CI: 1.03\u20131.20), and at the first (OR: 1.11; 95% CI: 1.03\u20131.20), second (OR: 1.09; 95% CI: 1.01\u20131.17), and third trimester (OR: 1.10; 95% CI: 1.02\u20131.18) per IQR (9.2\u2009\u00b5g\/m<jats:sup>3<\/jats:sup>) increase. Higher exposure to PM<jats:sub>2.5<\/jats:sub> was also associated with increased risk of small for gestational age (SGA). There were no statistically significant associations between PM<jats:sub>2.5<\/jats:sub> exposure and preterm births (PTB). Exposure to higher concentrations of PM<jats:sub>2.5<\/jats:sub> in Lima may decrease birth weight and increase the frequency of TLBW and SGA. Our study was inconsistent with the literature in finding no associations with preterm birth.<\/jats:p>","DOI":"10.1038\/s41370-020-0223-5","type":"journal-article","created":{"date-parts":[[2020,4,30]],"date-time":"2020-04-30T19:03:03Z","timestamp":1588273383000},"page":"689-697","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Association between maternal exposure to particulate matter (PM2.5) and adverse pregnancy outcomes in Lima, Peru"],"prefix":"10.1038","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5966-8978","authenticated-orcid":false,"given":"V. L.","family":"Tapia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. 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