Congenital abnormalities (CAs) remain a major cause of stillbirth and neonatal mortality. The literature has shown that congenital malformations are suggested to have multifactorial determinants, including environmental exposures and socioeconomic patterns. Moreover, since a decade, combined effects of environmental and socioeconomic characteristics are suspected to have an impact on the risk of congenital anomalies. Three mechanisms have been proposed in the literature suggesting the possible combined effect of the social health inequalities and the environmental exposures. This commentary presents the role of the neighbourhood deprivation in the adverse effect of air pollution on congenital anomalies. Both air pollution and neighbourhood deprivation have been reported in the literature to increase the risk of congenital abnormalities.