A new study published in the Nature Communications journal investigated the association of residential agricultural pesticide exposure during gestation, by trimester, and by toxicity with birth weight, gestational length, or birth abnormalities using individual birth and demographic characteristics for over 500 000 births during 1997–2011, in the agriculturally dominated area of San Joaquin Valley in California. It was found that for most births, there is no statistically identifiable effect of pesticide exposure on birth outcome. However, for individuals in the top 5% of exposure (~4200 kg of pesticides applied over gestation), pesticide exposure led to 5–9% increases in adverse outcomes, regardless of timing or toxicity of exposure. These effects are further enlarged for individuals in the top 1% of exposure (>11 000 kg over gestation), leading to an 11% increased probability of preterm birth, 20% increased probability of low birth weight, and ~30 g decrease in birth weight. Policies and interventions targeting the extreme right tail of pesticide exposure distribution could largely eliminate the adverse birth outcomes associated with agricultural pesticide exposure.