The present study investigated associations between traffic noise and air pollution and birth outcomes in several Alpine areas. We used data from two representative cross-sectional studies (UIT, n = 573 and BBT, n = 518) in the Tyrol Region (Austria and Italy). Only mothers who had lived in their current residence during the whole pregnancy were included. They completed a questionnaire, and medical records were used to draw data on birth weight, low birth weight (LBW), preterm birth, and small for gestational age (SGA). Road/railway traffic noise (Ldn, Lden) and air pollution (NO2) were assessed using a combination of sophisticated modelling and field measurements. In the UIT survey, higher Ldn was associated with higher odds of LBW, while no significant associations were observed for NO2. In the BBT survey, Lden was associated with lower birth weight in some subgroups and NO2 was associated with lower birth weight in preterm babies. Future studies should re-confirm the discovered associations of traffic emissions with birth outcomes in the Alpine region.