Green spaces and adverse pregnancy outcomes.
OBJECTIVE
The objective of this study was to evaluate the associations between proximity to green spaces and surrounding greenness and pregnancy outcomes, such as birth weight, low birth weight (LBW), very LBW (VLBW), gestational age, preterm deliveries (PTD) and very PTD (VPTD).


METHODS
This study was based on 39,132 singleton live births from a registry birth cohort in Tel Aviv, Israel, during 2000-2006. Surrounding greenness was defined as the average of satellite-based Normalised Difference Vegetation Index (NDVI) in 250 m buffers and proximity to major green spaces was defined as residence within a buffer of 300 m from boundaries of a major green space (5000 m(2)), based on data constructed from OpenStreetMap. Linear regression (for birth weight and gestational age) and logistic regressions models (for LBW, VLBW, PTD and VPTD) were used with adjustment for relevant covariates.


RESULTS
An increase in 1 interquartile range greenness was associated with a statistically significant increase in birth weight (19.2 g 95% CI 13.3 to 25.1) and decreased risk of LBW (OR 0.84, 95% CI 0.78 to 0.90). Results for VLBW were in the same direction but were not statistically significant. In general, no associations were found for gestational age, PTD and VPTD. The findings were consistent with different buffer and green space sizes and stronger associations were observed among those of lower socioeconomic status.


CONCLUSIONS
This study confirms the results of a few previous studies demonstrating an association between maternal proximity to green spaces and birth weight. Further investigation is needed into the associations with VLBW and VPTD, which has never been studied before.
Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Universitat Pompeu Fabra (UPF), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Keren
K
Agay-Shay
University of Haifa, Department of Geography and Environmental Studies, Faculty of Social Sciences Haifa 31905, Israel.
Ammatzia
A
Peled
Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Universitat Pompeu Fabra (UPF), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Antonia Valentín
AV
Crespo
Tel Aviv University, Department of Epidemiology, Faculty of Medicine, P.O.B. 39040, Ramat Aviv 69978, Israel.
Chava
C
Peretz
Bar Ilan University, Department of Management, Ramat Gan, 52900, Israel.
Yona
Y
Amitai
Unit of Clinical Epidemiology, Rambam Medical Center, P.O. B 9602, Haifa 31096, Israel.
Shai
S
Linn
Ben-Gurion University of the Negev, Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, P.O.B 653 Beersheba 84105, Israel.
Michael
M
Friger
Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Universitat Pompeu Fabra (UPF), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Mark J
MJ
Nieuwenhuijsen
D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D003116:Color; D004777:Environment; D005260:Female; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007557:Israel; D008297:Male; D016017:Odds Ratio; D010944:Plants; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth; D012042:Registries; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult
LBW; NDVI; PTD; adverse pregnancy outcomes