- Objective: To investigate the influence of operation "Cast Lead" on rates of preterm delivery (PTD) and other adverse pregnancy outcomes at the main region under missile attack during the operation. Methods: A retrospective cohort study comparing pregnancy and delivery outcomes of women who gave birth at the time of the military operation "Cast Lead" with women who gave birth at the same time period 1 and 2 years before and after the war. Results: Out of 1272 women exposed to stress during the war, there were 126 preterm deliveries (9.9%) as compared with 381 preterm deliveries (9.6%) among the 3984 women of the control group (p = 0.719). The group exposed to stress of the military campaign had significantly more preterm deliveries at gestational age 32-34 weeks (1.6% vs. 0.8%; RR = 2.04, p = 0.011). Conclusion: Military operation period was adversely associated with an increase in the rate of early PTD (<34 weeks gestation). From a public health perspective, pregnant women should be considered a special population and should be taken into account in a preparedness program for an emergency crisis and must be an important part of the public agenda and the state's infrastructure.