In October 2003 four contiguous prefectures in Greater Tokyo introduced Low Emission Zones (LEZs) from which diesel trucks and buses without particulate filters have been banned from entering. This paper analyzes the effects of this large-scale intervention on air quality, new vehicle registrations, and birthweights. We use a matching approach to construct a control group comparable to the designated areas in terms of propensity scores based on municipality characteristics during the pre-intervention period and apply a difference-in-differences design. We find evidence that the intervention led to reductions in hourly particulate matter concentrations and the incidence of low birthweights in the Greater Tokyo LEZ relative to the control group. We also find that the LEZs led to increases in registrations of new trucks and buses. This is not the case for passenger cars, which were exempt from the regulations. Our paper provides the first evidence of a significant link between LEZs and reduced incidence of low birthweights.