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Background: Cadmium is an extremely toxic metal with ubiquitous environmental distribution. Cadmium is a potent reproductive and developmental toxic agent, and intensive environmental exposure to this substance has been reported among the residents of Tehran. In this study, we investigated the correlation between amniotic fluid cadmium levels and the risk of preeclampsia, prematurity and low birth weight. Methods: This study was conducted on 341 hospitalized pregnant women. Amniotic fluid samples were obtained during childbirth, prepared by acid digestion, and cadmium concentration was determined using atomic absorption spectrophotometer equipped with a graphite furnace. Results: In this study, the mean amniotic fluid cadmium concentration in non-smokers was significantly lower (780± 0.231 µg/l) compared to smokers (13.4±0.91 µg/l). Increased amniotic fluid cadmium levels were associated with the reduction of birth weight, and birth weight was below 2500 g in all the cases with amniotic fluid cadmium levels of >15µg/l. Moreover, preeclampsia was more prevalent among smoking mothers compared to non-smokers. The total incidence rate of preeclampsia (12.6%) was significantly higher in this study compared to similar studies. In addition, no correlation was found between amniotic fluid cadmium levels and the rate of prematurity. Conclusion: According to the results of this study, cadmium levels of amniotic fluid could be used as sensitive and reliable biomarkers to monitor the reproductive and developmental toxicity of cadmium.