Objectives Exposure to environmental noise has been associated with an increased risk of cardiovascular diseases and diabetes, but evidence for occupational noise is limited and conflicting, especially related to pregnancy outcomes. This study aimed to evaluate the association of occupational noise exposure with hypertensive disorders of pregnancy (HDP) and gestational diabetes. Methods Our population-based cohort study utilized data on 1 109 516 singletons born to working mothers in Sweden between 1994-2014 from the Medical Birth Register and the Longitudinal Integration Database for Health Insurance and Labor Market Studies. Noise exposure came from a job exposure matrix (JEM) in five categories <70, 70-74, 75-80, 80-85, >85 dB(A). Relative risks (RR), adjusted for confounders and other job exposures, were calculated by modified Poisson regressions for the full sample and a subsample of first-time mothers reporting full-time work. Results Exposure to 80-85 dB(A) of noise was associated with an increased risk of all HDP [RR 1.12, 95% confidence interval (CI) 1.05-1.18] and preeclampsia alone (RR 1.14, 95% CI 1.07-1.22) in the full sample. Results were similar for first-pregnancy, full-time workers. Exposure to >85 dB(A) of noise was also associated with an increased risk of gestational diabetes (RR 1.57, 95% CI 1.10-2.24) in the analysis restricted to first-time mothers working full-time. Conclusion In this study, exposure to noise was associated with an increased risk for HDP and gestational diabetes, particularly in first-time mothers who work full-time. Further research is needed to confirm findings and identify the role of hearing protection on this association so prevention policies can be implemented.