A population-based cohort study of electronic tolling, traffic congestion, and adverse birth outcomes

[Display omitted] •Electronic tolling implementation leads to minimal changes in local traffic.•Adverse birth outcomes have little evidence of association with electronic tolling implementation.•Births within 500 m of a tolled road show some evidence of a reduced association between toll booth removal and preterm birth. Although traffic-related air pollution is largely regulated at the federal level, congestion reduction projects may reduce local traffic and air pollution to levels that create positive co-benefits for population health. In recent years, many urban areas have implemented electronic tolling systems to improve traffic conditions. Quantify associations between implementing electronic tolling and local changes in traffic and infant health. Using a population-based birth cohort (Texas, 1999–2016), we calculated residential proximity to the nearest tolled road segment within 5 km (n = 625,279) and examined changes in local traffic before and after toll implementation. Using a difference-in-differences design, we compared four markers of adverse birth outcomes (term birth weight, term low birth weight, preterm birth, very preterm birth) among infants from pregnant people residing