Testing the Multiple Pathways of Residential Greenness to Pregnancy Outcomes Model in a Sample of Pregnant Women in the Metropolitan Area of Donostia-San Sebastián.

Asier Anabitarte,Gonzalo García-Baquero,Mikel Subiza-Pérez,Kristina W. Whitworth,Kepa Azkona,Guillem Vich,Jesús Ibarluzea,Carme Miralles-Guasch,Aitana Lertxundi,Jon Irazusta

doi:10.3390/ijerph17124520

Abstract

Residential greenness may positively impact diverse human health indicators through the reduction of air pollution, the improvement of psychological health, and the promotion of physical activity. Previous studies indicate a weak but positive association with pregnancy outcomes. Our aim was to test the multiple pathways from residential greenness to pregnancy outcomes model, using residential NO2 concentrations, psychological health, and moderate-to-vigorous physical activity (MVPA) during the first trimester of pregnancy, in a sample of 440 pregnant women residing in Donostia, Spain. Three metrics of residential greenness were calculated around each participant’s home address: normalized difference vegetation index (NDVI) within 300 m, and green space (>5000 m2) availability within 300 and 500 m. Residential NO2 concentrations, psychological health, and MVPA were explored as mediators of the associations between these metrics and the following pregnancy outcomes: birth weight (BW), low birth weight (LBW), prematurity, small for gestational age (SGA), and large for gestational age (LGA). Educational attainment, parity, and body mass index (BMI) were treated as covariates. Counterfactual mediation analyses showed very low to null statistical support for an association between any of the greenspace metrics and pregnancy outcomes in the full sample. Green space availability (300 m) was associated with lower BW and showed a marginal protective effect against LGA.

Highlights

Green infrastructure, which encompasses urban forests, parks, green roofs, street trees, and flowers, provides a wide array of ecosystem services that are of great interest for human health [1]
We briefly review current literature on (1) the association of residential greenness and the three proposed mediators and (2) the association between those mediators and the pregnancy outcomes selected for this study (Figure 1)
These results indicate that participants living in the vicinity of a green space of more than 5000 m2 delivered children with lower average birthweights and were exposed to lower NO2 concentrations, and those living in greener environments performed less activity at moderate-to-vigorous intensities per day

Summary

Introduction

Green infrastructure, which encompasses urban forests, parks, green roofs, street trees, and flowers, provides a wide array of ecosystem services that are of great interest for human health [1]. Researchers are aware of the impact of greenness on pregnancy outcomes [9], which are of utmost importance due to their association with cognitive development, medical conditions, and morbidity and mortality in later stages of life [10,11,12]. The literature in this area suggests that residential greenness weakly but significantly reduces the risk of small for gestational age and preterm birth and increases birth weight [13,14,15,16,17,18,19]. Some studies have shown negative effects of residential greenness on pregnancy outcomes [22,23]

Methods

Discussion

Conclusion