The purpose of this study was to determine if elevated ambient exposure to incinerator generated polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) may affect birth outcomes of exposed infants born in Taipei metropolitan areas, Taiwan. The relationships between exposure to elevated PCDD/Fs concentration and various birth outcomes including birth weight, gestational age, and proportion of females were cross-sectionally assessed in 1991 (one year before the incinerator started to operate) and 1997 (five years later), respectively. We used the US EPA Industrial Source Complex Model-Sort Term modeling technique to determine the ambient PCDD/Fs concentrations in the study areas, in which 40 districts with annual averaged PCDD/Fs exposure of > or = 0.03 pg TEQ/m3 were considered as the exposed areas and another 40 districts with an estimated concentration of zero were randomly selected as reference areas. Information on birth outcomes was retrieved from the Taiwan's Birth Registry. A total of 6697 and 6282 neonates were included in the analysis for 1991 and 1997, respectively. After controlling for potential confounders, the results showed that the odds ratios (ORs) of low birth weight (< 2500 g) for higher exposures were 0.94 (> 0.05 pg TEQ/m3) and 091 (0.03-0.05 pg TEQ/m3) in 1991 and were 1.07 (> 0.05 pg TEQ/m3) and 1.06 (0.03-0.05 pg TEQ/m3) in 1997. The corresponding ORs were 1.05/0.86 (1991) and 1.12/1.22 (1997) for preterm (< 37 completed weeks of gestation), as well as 0.95/1.00 (1991) and 0.95/0.90 (1997) for female births. The above ORs were all close to unity and were statistically insignificant. When birth weight was analyzed as a continuous variable, the difference in mean birth weight between exposed group (> 0.03 pg TEQ/m3) and reference group decreased from 3.02 g in 1991 to -5.87 g in 1997. Analysis of continuous data also showed that the mean difference in gestational age between exposed and reference areas decreased from 0.05 weeks in 1991 to -0.09 week (p<0.05) in 1997. This study tends to conclude that the incinerator generated dioxin poses little effects on birth weight and female birth, but might pose small effects on gestational age. If the observed adverse effects turn out to be real, the measures now taken for improvement of abatement of waste gases seem to be a wise thing to do.