BACKGROUND: Tobacco-smoke, airborne, and dietary exposures to polycyclic hydrocarbons (PAHs) have been associated with reduced prenatal growth. from biomarker-based studies of low-exposed populations is limited. adducts in cord blood reflect the prenatal effective dose to several agents including PAHs. OBJECTIVES: We estimated the association between adduct levels and birth weight in a multicenter study and examined of this association by maternal fruit and vegetable intake during METHODS: Pregnant women from Denmark, England, Greece, Norway, and Spain recruited in 2006-2010. Adduct levels were measured by the 32P- technique in white blood cells from 229 mothers and 612 newborns. was examined through questionnaires. RESULTS: Adduct levels in maternal blood samples were similar and positively correlated (median, 12.1 vs. adducts in 108 nucleotides; Spearman rank correlation coefficient=0.66, Cord blood adduct levels were negatively associated with birth weight, estimated difference in mean birth weight of -129 g (95% CI: -233, -25) infants in the highest versus lowest tertile of adducts. The negative with birth weight was limited to births in Norway, Denmark, and England, countries with the lowest adduct levels, and was more pronounced in mothers with low intake of fruit and vegetables (-248 g; 95% CI: -405, - compared to those with high intake (-58 g; 95% CI: -206, 90) Maternal exposure to genotoxic agents that induce the formation of bulky adducts may affect intrauterine growth. Maternal fruit and vegetable may be protective.