Apart from demographic, socio-economic, behavioral, nutritional and medico-obstetrical factors, environmental factors have been suggested to be associated with adverse pregnancy outcomes, such as preterm birth, low birth weight or hypertensive disorders. According to a recent review of the literature, there is some suggestive evidence of adverse associations with environmental noise especially for low birth weight. However, the way these individual and environmental vulnerabilities combine has been scarcely studied. The objective of this study was to describe the accumulation of individual, socio-economics, medical and environmental vulnerability markers and to assess their association with adverse pregnancy outcomes.\n\nMethods\nAll the women living in the city of Besançon who delivered a singleton pregnancy at the University Hospital between 2005 and 2009 were included. Individual data were collected from obstetrical records. Long term environmental exposures to noise and air pollution were assessed using environmental prediction models. Finally, 16 vulnerability markers were retained; the occurrence of preterm birth, low birth weight, preeclampsia, and vaginal bleeding during the second or third trimester were considered for analyses.\n\nResults\nAmong the 3701 study women, 28% showed a socio-economic vulnerability, 30% a medico-obstetrical. Near 40% of the women presented environmental vulnerabilities, and 21% were exposed to a noise level above 55 dB(A) during the night. Although no vulnerability marker was observed among 18% of the women, 27% accumulated three or more of the 16 vulnerability markers. A significant and linear association was observed between the cumulative number of vulnerability markers and the occurrence of adverse pregnancy outcomes.\n\nConclusion\nThis study illustrates the interest of a multi criteria approach in health risk assessment, especially when considering environmental noise exposure and its potential impact on maternal and child health.