title: Surrounding greenness, proximity to city parks and pregnancy outcomes in Kaunas cohort study.
abstract: There is increasing evidence that green space can improve the health and well-being of urban residents. However, there has been no consistent evidence of the effect of city parks on reproductive health. We investigated whether surrounding greenness levels and/or distance to city parks affect birth outcomes. This study was based on 3292 singleton live-births from the Kaunas birth cohort, Lithuania (2007-2009), who were enrolled in the FP7 PHENOTYPE project study. Residential surrounding greenness level was ascertained as average of satellite-based normalized difference vegetation index (NDVI) within buffers of 100 m, 300 m, and 500 m of each maternal home and distance to a city park was defined as distance to boundaries of the nearest city park. For each indicator of green space exposure, linear or logistic regression models were constructed to estimate change in birth outcomes adjusted for relevant covariates. An increase in distance to a city parks was associated with an increase in risk of preterm birth and decrease of gestational age. We found a statistically significant association between low surrounding greenness and term low birth weight. After assessing effect modification based on the low surrounding greenness (NDVI-500<median) and the distance to city parks (>1000 m), we found increased risks for low birth weight (OR 2.23, 1.20-4.15), term low birth weight (OR 2.97, 1.04-8.45) and preterm birth (OR 1.77, 1.10-2.81) for subjects with low surrounding greenness and farther distance from a park. Both higher surrounding greenness level and proximity to park have beneficial effects on pregnancy outcomes. A beneficial park effect on foetal growth is most apparent in the environment with low surrounding greenness level. Further investigation is needed to confirm this association.
authors.affiliation: Department of Environmental Science, Vytautas Magnus University, K. Donelaicio 58, Kaunas 44248, Lithuania. Electronic address: a.grazuleviciene@gmf.vdu.lt.
authors.forename: Regina
authors.initials: R
authors.lastname: Grazuleviciene
authors.affiliation: Department of Environmental Science, Vytautas Magnus University, K. Donelaicio 58, Kaunas 44248, Lithuania. Electronic address: a.danileviciute@gmf.vdu.lt.
authors.forename: Asta
authors.initials: A
authors.lastname: Danileviciute
authors.affiliation: Department of Environmental Science, Vytautas Magnus University, K. Donelaicio 58, Kaunas 44248, Lithuania. Electronic address: a.dedele@gmf.vdu.lt.
authors.forename: Audrius
authors.initials: A
authors.lastname: Dedele
authors.affiliation: Department of Environmental Science, Vytautas Magnus University, K. Donelaicio 58, Kaunas 44248, Lithuania. Electronic address: j.vencloviene@gmf.vdu.lt.
authors.forename: Jone
authors.initials: J
authors.lastname: Vencloviene
authors.affiliation: Department of Environmental Science, Vytautas Magnus University, K. Donelaicio 58, Kaunas 44248, Lithuania. Electronic address: s.andrusaityte@gmf.vdu.lt.
authors.forename: Sandra
authors.initials: S
authors.lastname: Andrusaityte
authors.affiliation: Department of Environmental Science, Vytautas Magnus University, K. Donelaicio 58, Kaunas 44248, Lithuania. Electronic address: i.uzdanaviciute@gmf.vdu.lt.
authors.forename: Inga
authors.initials: I
authors.lastname: Uždanaviciute
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader 88, Barcelona 08003, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. Electronic address: mnieuwenhuijsen@creal.cat.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Nieuwenhuijsen
mesh_terms: D000328:Adult; D001724:Birth Weight; D002947:Cities; D003116:Color; D004777:Environment; D005260:Female; D047109:Fetal Development; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008097:Lithuania; D008297:Male; D016017:Odds Ratio; D000068316:Parks, Recreational; D010944:Plants; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth; D014505:Urban Population; D055815:Young Adult
keywords: Adverse pregnancy outcomes; Distance to park; Effect modification; Green space; Surrounding greenness