This study aimed to assess long-term changes in pregnancy and birth outcomes after the Great East Japan Earthquake and the accident at the Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Plant in Fukushima Prefecture.　This is the final report on perinatal outcomes of the Prefectural Health Survey, which ended after a 10-year observation period.　Questionnaires based on a pregnancy and birth survey conducted by the Radiation Medical Science Center for the Fukushima Health Management Survey were sent to women who had received maternal and child health handbooks from municipal officers in Fukushima Prefecture.　Annual data from six geographic areas in Fukushima Prefecture were separately analyzed.　The number of eligible respondents, which was approximately 16,000 in 2011 when the earthquake occurred, declined temporarily the following year, recovered temporarily one year later, and has gradually declined since then.　However, the response rate remained at approximately 50% throughout the decade.　The incidence of preterm deliveries, low-birthweight infants, and congenital anomalies did not vary over the decade and showed a similar trend in national surveys and general reports.　Our analysis shows that the disaster had no significant adverse perinatal outcomes in Fukushima Prefecture and we recommend measures to ensure the safe delivery of babies in the region.