Greenness and Adverse Pregnancy Outcomes in Tel-Aviv during 2000-2014

Abstract

Background: Longitudinal evidence of beneficial associations between exposure to greenness and pregnancy outcomes are limited. Our objective was to evaluate these associations among 78,671 livebirths in Tel Aviv, Israel.Methods: longitudinal exposure to mean greenness during pregnancy and trimesters were calculated using satellite-based Normalised Difference Vegetation Index (NDVI) from MODIS 8-days interval data. In addition, exposure to mean NDVI from high-resolution satellite (RapidEye) and percent of tree cover (Vegetation Continuous Fields (VCF)) at various radii (100m, 300m and 500m), were evaluated in a cross-sectional approach. Generalized linear models were used to evaluate the associations between greenness and pregnancy outcomes in crude and adjust models.Results: In models adjusted for individual and neighborhood-level markers of socioeconomic status (SES), highest tertile of exposure to mean NDVI during pregnancy was associated with a statistically significant increase in birth weight (3rd/1st tertile increased mean birth weight in 13.2 g 95% CI: 5.0, 21.4) and decreased odds of very preterm delivery (PTD) (3rd/1st tertile OR: 0.80, 95 %CI: 0.64, 1.00). The strongest associations for birth weight observed during the first trimester and for very PTD during the second trimester. Associations for the cross-sectional approach were similar and in addition decreased odds of small for gestational age (SGA) and low birth weight (non-linear associations) were observed. Associations with NDVI were stronger than the associations with tree cover. Associations were consistent for further adjustment and stronger for low SES.Conclusion: Consistent beneficial associations using different greenness measures and approaches are reported. Further studies should use the longitudinal approach because it allows us to understand when exposure during pregnancy to green environment is the most beneficial for pregnancy outcomes.