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Ahmer Z, Atif M, Zaheer S, Adil O, Shaikh S, Shafique K. Association between residential green spaces and pregnancy outcomes: a systematic review and meta-analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024:1-18. [PMID: 38185100 DOI: 10.1080/09603123.2023.2299242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
Residential exposure to greenness has shown positive influences on pregnancy outcomes like birth weight, preterm births, and small to gestational age (SGA) deliveries. We aimed to comprehensively review and investigate these associations by conducting a systematic review with meta-analysis. Relevant studies were retrieved from PubMed, EMBASE, ScienceDirect, and Google Scholar databases before June 2023. Summary effect estimates included birth weight, low birth weight (LBW), preterm births, and SGA which were calculated for 0.1 unit increase in residential greenness exposure. Overall quality of the evidence was examined through Joanna Briggs Institute (JBI) critical appraisal tool. The review included 31 articles and found a statistically significant increase in birth weight measured at 250 m buffer distance (β = 8.95, 95% CI = 1.63-16.27). Green spaces were also associated with lower odds of LBW (OR = 0.97, 95% CI = 0.96-0.98). Residential greenness had positive impacts on pregnancy outcomes that calls for emphasis on urban planning, especially in developing countries.
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Affiliation(s)
- Zaeema Ahmer
- APPNA Institute of Public Health, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
- School of Public Health, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Maria Atif
- School of Public Health, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Sidra Zaheer
- School of Public Health, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Omair Adil
- School of Public Health, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Shiraz Shaikh
- APPNA Institute of Public Health, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | - Kashif Shafique
- School of Public Health, Dow University of Health Sciences, Karachi, Sindh, Pakistan
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Torres Toda M, Avraam D, James Cadman T, Fossati S, de Castro M, Dedele A, Donovan G, Elhakeem A, Estarlich M, Fernandes A, Gonçalves R, Grazuleviciene R, Harris JR, Harskamp-van Ginkel MW, Heude B, Ibarluzea J, Iñiguez C, Wv Jaddoe V, Lawlor D, Lertxundi A, Lepeule J, McEachan R, Moirano G, Lt Nader J, Nybo Andersen AM, Pedersen M, Pizzi C, Roumeliotaki T, Santos S, Sunyer J, Yang T, Vafeiadi M, Gm Vrijkotte T, Nieuwenhuijsen M, Vrijheid M, Foraster M, Dadvand P. Exposure to natural environments during pregnancy and birth outcomes in 11 European birth cohorts. ENVIRONMENT INTERNATIONAL 2022; 170:107648. [PMID: 36436464 DOI: 10.1016/j.envint.2022.107648] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/25/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
Research suggests that maternal exposure to natural environments (i.e., green and blue spaces) promotes healthy fetal growth. However, the available evidence is heterogeneous across regions, with very few studies on the effects of blue spaces. This study evaluated associations between maternal exposure to natural environments and birth outcomes in 11 birth cohorts across nine European countries. This study, part of the LifeCycle project, was based on a total sample size of 69,683 newborns with harmonised data. For each participant, we calculated seven indicators of residential exposure to natural environments: surrounding greenspace in 100m, 300m, and 500m using Normalised Difference Vegetation Index (NDVI) buffers, distance to the nearest green space, accessibility to green space, distance to the nearest blue space, and accessibility to blue space. Measures of birth weight and small for gestational age (SGA) were extracted from hospital records. We used pooled linear and logistic regression models to estimate associations between exposure to the natural environment and birth outcomes, controlling for the relevant covariates. We evaluated the potential effect modification by socioeconomic status (SES) and region of Europe and the influence of ambient air pollution on the associations. In the pooled analyses, residential surrounding greenspace in 100m, 300m, and 500m buffer was associated with increased birth weight and lower odds for SGA. Higher residential distance to green space was associated with lower birth weight and higher odds for SGA. We observed close to null associations for accessibility to green space and exposure to blue space. We found stronger estimated magnitudes for those participants with lower educational levels, from more deprived areas, and living in the northern European region. Our associations did not change notably after adjustment for air pollution. These findings may support implementing policies to promote natural environments in our cities, starting in more deprived areas.
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Affiliation(s)
- Maria Torres Toda
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain.
| | - Demetris Avraam
- Population Health Sciences Institute, Newcastle University, Newcastle, UK; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Timothy James Cadman
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.
| | - Serena Fossati
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain.
| | - Montserrat de Castro
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain.
| | - Audrius Dedele
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, 53361 Akademija, Lithuania.
| | - Geoffrey Donovan
- Center for Public Health Research, Massey University-Wellington Campus, PO Box 756, Wellington 6140, New Zealand; USDA Forest Service, PNW Research Station, 620 SW Main, Suite 502, Portland, OR 97205, USA.
| | - Ahmed Elhakeem
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Science, Bristol Medical School, University of Bristol, UK.
| | - Marisa Estarlich
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain; Epidemiology and Environmental Health Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIO-Public Health, FISABIO-Universitat Jaume I-Universitat de València, Av. Catalunya 21, 46020, Valencia, Spain; Nursing School, Universitat de València, C/Menendez y Pelayo, s/n, 46010, Valencia, Spain.
| | - Amanda Fernandes
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.
| | - Romy Gonçalves
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
| | - Regina Grazuleviciene
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, 53361 Akademija, Lithuania.
| | - Jennifer R Harris
- Center for Fertility and Health, The Nowegian Institute of Public Health, Oslo, Norway.
| | - Margreet W Harskamp-van Ginkel
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, Netherlands.
| | - Barbara Heude
- Université de Paris Cité, Inserm, INRAE, Centre of Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France.
| | - Jesús Ibarluzea
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain; Biodonostia Health Research Institute, Environmental Epidemiology and Child Development Group, 20014, San Sebastian, Spain; Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, 20013, San Sebastian, Spain; Faculty of Psychology of the University of the Basque Country, 20018, San Sebastian, Spain.
| | - Carmen Iñiguez
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain; Epidemiology and Environmental Health Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIO-Public Health, FISABIO-Universitat Jaume I-Universitat de València, Av. Catalunya 21, 46020, Valencia, Spain; Department of Statistics and Operational Research, Universitat de València, Dr. Moliner, 50 46100, Valencia, Spain.
| | - Vincent Wv Jaddoe
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Deborah Lawlor
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Science, Bristol Medical School, University of Bristol, UK.
| | - Aitana Lertxundi
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain; Biodonostia Health Research Institute, Environmental Epidemiology and Child Development Group, 20014, San Sebastian, Spain; Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), 48940, Leioa, Spain.
| | - Johanna Lepeule
- Université Grenoble Alpes, Institut Albert Bonniot, équipe d'épidémiologie environnementale appliquée à la reproduction et la santé respiratoire, F-38000 Grenoble, France; Inserm, Institut Albert Bonniot, équipe d'épidémiologie environnementale appliquée à la reproduction et la santé respiratoire, F-38000 Grenoble, France.
| | - Rosemary McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
| | - Giovenale Moirano
- Department of Medical Sciences, University of Turin, CPO-Piemonte, Turin, Italy.
| | - Johanna Lt Nader
- Department of Genetics and Bioinformatics, Division of Health Data and Digitalisation, Norwegian Institute of Public Health, Oslo, Norway.
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Marie Pedersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Costanza Pizzi
- Department of Medical Sciences, University of Turin, CPO-Piemonte, Turin, Italy.
| | - Theano Roumeliotaki
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Social Medicine, School of Medicine, University of Crete, Greece.
| | - Susana Santos
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Portugal.
| | - Jordi Sunyer
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain.
| | - Tiffany Yang
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
| | - Marina Vafeiadi
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Social Medicine, School of Medicine, University of Crete, Greece.
| | - Tanja Gm Vrijkotte
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, Netherlands.
| | - Mark Nieuwenhuijsen
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain.
| | - Martine Vrijheid
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain.
| | - Maria Foraster
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain.
| | - Payam Dadvand
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain.
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Nguyen PY, Astell-Burt T, Rahimi-Ardabili H, Feng X. Green Space Quality and Health: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11028. [PMID: 34769549 PMCID: PMC8582763 DOI: 10.3390/ijerph182111028] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/28/2021] [Accepted: 10/08/2021] [Indexed: 12/18/2022]
Abstract
(1) Background: As cities densify, researcher and policy focus is intensifying on which green space types and qualities are important for health. We conducted a systematic review to examine whether particular green space types and qualities have been shown to provide health benefits and if so, which specific types and qualities, and which health outcomes. (2) Methods: We searched five databases from inception up to June 30, 2021. We included all studies examining a wide range of green space characteristics on various health outcomes. (3) Results: 68 articles from 59 studies were found, with a high degree of heterogeneity in study designs, definitions of quality and outcomes. Most studies were cross-sectional, ecological or cohort studies. Environment types, vegetation types, and the size and connectivity of green spaces were associated with improved health outcomes, though with contingencies by age and gender. Health benefits were more consistently observed in areas with greater tree canopy, but not grassland. The main outcomes with evidence of health benefits included allergic respiratory conditions, cardiovascular conditions and psychological wellbeing. Both objectively and subjectively measured qualities demonstrated associations with health outcomes. (4) Conclusion: Experimental studies and longitudinal cohort studies will strengthen current evidence. Evidence was lacking for needs-specific or culturally-appropriate amenities and soundscape characteristics. Qualities that need more in-depth investigation include indices that account for forms, patterns, and networks of objectively and subjectively measured green space qualities.
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Affiliation(s)
- Phi-Yen Nguyen
- School of Population Health, University of New South Wales, Sydney, NSW 2033, Australia; (P.-Y.N.); (H.R.-A.)
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong, NSW 2522, Australia;
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong, NSW 2522, Australia;
- School of Health and Society, Faculty of Arts, Social Sciences, and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Hania Rahimi-Ardabili
- School of Population Health, University of New South Wales, Sydney, NSW 2033, Australia; (P.-Y.N.); (H.R.-A.)
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong, NSW 2522, Australia;
| | - Xiaoqi Feng
- School of Population Health, University of New South Wales, Sydney, NSW 2033, Australia; (P.-Y.N.); (H.R.-A.)
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong, NSW 2522, Australia;
- School of Health and Society, Faculty of Arts, Social Sciences, and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
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Green Space and Health Equity: A Systematic Review on the Potential of Green Space to Reduce Health Disparities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052563. [PMID: 33806546 PMCID: PMC7967323 DOI: 10.3390/ijerph18052563] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023]
Abstract
Disadvantaged groups worldwide, such as low-income and racially/ethnically minoritized people, experience worse health outcomes than more privileged groups, including wealthier and white people. Such health disparities are a major public health issue in several countries around the world. In this systematic review, we examine whether green space shows stronger associations with physical health for disadvantaged groups than for privileged groups. We hypothesize that disadvantaged groups have stronger protective effects from green space because of their greater dependency on proximate green space, as they tend to lack access to other health-promoting resources. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method and search five databases (CINAHL, Cochrane, PubMed, Scopus, and Web of Science) to look for articles that examine whether socioeconomic status (SES) or race/ethnicity modify the green space-health associations. Based on this search, we identify 90 articles meeting our inclusion criteria. We find lower-SES people show more beneficial effects than affluent people, particularly when concerning public green spaces/parks rather than green land covers/greenness. Studies in Europe show stronger protective effects for lower-SES people versus higher-SES people than do studies in North America. We find no notable differences in the protective effects of green space between racial/ethnic groups. Collectively, these results suggest green space might be a tool to advance health equity and provide ways forward for urban planners, parks managers, and public health professionals to address health disparities.
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Mygind L, Kurtzhals M, Nowell C, Melby PS, Stevenson MP, Nieuwenhuijsen M, Lum JAG, Flensborg-Madsen T, Bentsen P, Enticott PG. Landscapes of becoming social: A systematic review of evidence for associations and pathways between interactions with nature and socioemotional development in children. ENVIRONMENT INTERNATIONAL 2021; 146:106238. [PMID: 33189991 DOI: 10.1016/j.envint.2020.106238] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Existing research indicates that spending time in nature is associated with diverse aspects of children's health and wellbeing. Although fundamental to later life chances and health, no systematic reviews, to our knowledge, have focused specifically on the effects of interaction with nature on socioemotional functioning in childhood. OBJECTIVES Amongst children, what is the consistency of associations between the availability of or spending time in nature on socioemotional function and development? Furthermore, which child behaviours and states independently associate with socioemotional function and availability of or spending time in nature, and what is the consistency of associations between these behaviours and states and contact with nature? DATA SOURCES Embase, Environment Complete, MEDLINE, and APA PsycINFO. Eligible studies were backward and forward snowball-searched. STUDY ELIGIBILITY CRITERIA Studies investigating effects of, or associations between, availability of or interaction with nature on socioemotional or proximal outcomes in children under the age of 12 years were included in this review. STUDY APPRAISAL AND SYNTHESIS METHODS The internal validity of studies investigating socioemotional outcomes were based on assessments of elements of study design, conduct, and reporting to identify potential issues related to confounding or other biases. The number of analyses indicating positive, negative, and non-significant associations between availability or interaction with green space and the outcomes were summed. RESULTS A total of 223 eligible full-texts, of which 43 pertained to socioemotional outcomes and 180 to proximal outcomes, met eligibility criteria. Positive associations between availability of and spending time in green space were found with children's intra- and interpersonal socioemotional function and development. Proportions of positive findings ranged from 13.9% to 55% across experimental and observational research, exposures, populations, and contexts. Modifying and mediating factors were identified. We found consistent evidence for improved aspects of cognition and, for children over six years, reduced risk of obesity and overweight in association with green space; consistent links between movement behaviours in the experimental, but not observational research; tentative trends suggesting associations with play, motor skills, language, screen time, and communication skills; little evidence for positive associations between green space and mood, physical wellbeing, and stress; some evidence for associations with healthy birth outcomes, and little evidence for direct associations between availability of green space and asthma and allergy prevalence, however, mediation via, for example, air pollution was likely. LIMITATIONS We identified few studies without either probable or severe risk of bias in at least one item. Improved study quality may therefore result in different results. Restricting analyses to include only studies considered at low risk of bias indicated similar or slightly lower proportions of positive findings. Risk of bias in proximal outcomes was not assessed. CONCLUSIONS The empirical evidence for benefits of availability of and interaction green space for child socioemotional function and development must currently be considered limited. A number of proximal indicators were identified. Systematic review registration number. PROSPERO ID CRD42019135016.
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Affiliation(s)
- Lærke Mygind
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia; Unit of Medical Psychology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark.
| | - Mette Kurtzhals
- Health Promotion Research, Steno Diabetes Center Copenhagen, The Capital Region of Denmark, Gentofte, Denmark
| | - Clare Nowell
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - Paulina S Melby
- Section of Sport, Individual and Society, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Matt P Stevenson
- Health Promotion Research, Steno Diabetes Center Copenhagen, The Capital Region of Denmark, Gentofte, Denmark
| | - Mark Nieuwenhuijsen
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiologia y Salud Publica, Madrid, Spain
| | - Jarrad A G Lum
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - Trine Flensborg-Madsen
- Unit of Medical Psychology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Peter Bentsen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark; Department of Geoscience and Natural Resource Management, University of Copenhagen, Frederiksberg, Denmark
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
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Lee KJ, Moon H, Yun HR, Park EL, Park AR, Choi H, Hong K, Lee J. Greenness, civil environment, and pregnancy outcomes: perspectives with a systematic review and meta-analysis. Environ Health 2020; 19:91. [PMID: 32854706 PMCID: PMC7457282 DOI: 10.1186/s12940-020-00649-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/21/2020] [Indexed: 05/19/2023]
Abstract
BACKGROUND Various maternal conditions, especially in utero conditions and prenatal exposure to environments with air pollution and greenness, have been reviewed to address the enhancement and prevention of susceptibility to health risks, including low birthweight, preterm delivery, and preeclampsia. This study aimed to qualitatively and quantitatively investigate the associations between pregnancy outcomes and the characteristics of surrounding living environment, including greenness, air pollution, and civilization. METHODS A secondary search of the MEDLINE, EMBASE, Cochrane Library, K-eArticles, and CINAHL databases was conducted without language restrictions to identify the relevant publications from the time of inception of the databases to April 2019. RESULTS A total of 89 studies were identified, and 10 were included in the quantitative synthesis. The greenness of the environment within 100-, 250- and 500-m buffers, after adjusting for the air quality and civilization factors, was weakly but positively associated with birthweight. The pooled regression slope was 0.00134 (95% confidence interval [CI], 0.000, 0.0020). The greenness of the environment was also associated with a significant decrease in the incidence of poor pregnancy outcomes, namely, low birthweight, small for gestational age (odds ratio [OR] 0.94; 95% CI, 0.92, 0.97), and preterm delivery (OR 0.98; 95% CI, 0.97, 0.99). CONCLUSIONS The greenness of the environment had a positive effect on the pregnancy outcomes, despite poor air quality and civilization. Following urbanization, planning for greenness management, environmental medicine, and public health is important and thus should be proposed as preventive methods as way of increasing birthweight and life expectancy.
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Affiliation(s)
- Kyung Ju Lee
- Department of Obstetrics and Gynecology, Korea University Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea.
- Department of Public Health, Korea University Graduate School, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
| | - Hyemi Moon
- Department of Biostatistics, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, South Korea
| | - Hyo Ri Yun
- Department of Biostatistics, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, South Korea
| | - Eun Lyeong Park
- Department of Biostatistics, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, South Korea
| | - Ae Ran Park
- Department of Biostatistics, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, South Korea
| | - Hijeong Choi
- Graduate School of Integrative Medicine, Cha University, Pocheon-si, Gyeonggi-do, South Korea
| | - Kwan Hong
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
- Department of Public Health, Korea University Graduate School, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, South Korea.
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Akaraci S, Feng X, Suesse T, Jalaludin B, Astell-Burt T. A Systematic Review and Meta-Analysis of Associations between Green and Blue Spaces and Birth Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082949. [PMID: 32344732 PMCID: PMC7215926 DOI: 10.3390/ijerph17082949] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022]
Abstract
Previous studies suggest that green and blue spaces may promote several health outcomes including birth outcomes. However, no synthesis of previous work has specifically asked policy-relevant questions of how much and what type is needed in every neighborhood to elicit these benefits at the population level. A systematic review and meta-analyses were conducted to synthesize thirty-seven studies on the association between residential green and blue spaces and pregnancy outcomes. Meta-analyses were performed for birth weight (BW), small for gestational age (SGA), low birth weight (LBW) and preterm birth (PTB). Increase in residential greenness was statistically significantly associated with higher BW [β = 0.001, 95%CI: (<0.001, 0.002)] and lower odds of SGA [OR = 0.95, 95%CI: (0.92, 0.97)]. Associations between green space and LBW and PTB were as hypothesized but not statistically significant. Associations between blue spaces and pregnancy outcomes were not evident. No study explicitly examined questions of threshold, though some evidence of nonlinearity indicated that moderate amounts of green space may support more favorable pregnancy outcomes. Policy-relevant green and blue space exposures involving theory-driven thresholds warrant testing to ensure future investments in urban greening promote healthier pregnancy outcomes.
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Affiliation(s)
- Selin Akaraci
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia; (S.A.); (X.F.)
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia; (S.A.); (X.F.)
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW 2006, Australia
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention (China CDC), Beijing 102206, China
| | - Thomas Suesse
- NIASRA, National Institute for Applied Statistics Research Australia School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, University of New South Wales, Sydney, NSW 2170, Australia;
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia; (S.A.); (X.F.)
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW 2006, Australia
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention (China CDC), Beijing 102206, China
- School of Public Health, Peking Union Medical College and The Chinese Academy of Medical Sciences, Beijing 100730, China
- Correspondence:
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Agay-Shay K, Michael Y, Basagaña X, Martínez-Solanas È, Broday D, Lensky IM, Rudolf M, Rubin L, Kent R, Levy N, Haklai Z, Grotto I. Mean and variance of greenness and pregnancy outcomes in Tel Aviv during 2000–14: longitudinal and cross-sectional approaches. Int J Epidemiol 2018; 48:1054-1072. [DOI: 10.1093/ije/dyy249] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2018] [Indexed: 01/02/2023] Open
Abstract
Abstract
Background
Natural environments may have beneficial impacts on pregnancy outcomes. However, longitudinal evidence is limited and the associations with variance in surrounding greenness is unknown. Our objective was to evaluate these associations among 73 221 live births in Tel Aviv, Israel.
Methods
Longitudinal exposure to mean of greenness during pregnancy and trimesters were calculated using satellite-based Moderate Resolution Imaging Spectroradiometer (MODIS) Normalised Difference Vegetation Index (NDVI) data. In addition, exposure to mean and variation of NDVI from high-resolution satellite and percentage of tree cover [Vegetation Continuous Fields (VCF)] at 300-m buffer were evaluated in a cross-sectional approach. Generalized linear models were used to estimate the crude and adjusted associations. We explore the possible mediating role of ambient exposures and distance to ‘outdoor gyms’ located in parks.
Results
Crude beneficial associations between exposure to higher mean NDVI during pregnancy and pregnancy outcomes were observed [for birthweight, 3rd/1st tertile exposure increased the mean by 25.5 g, 95% confidence intervals (CIs): 15.4, 35.5] and decreased the odds of low birthweight, small for gestational age, preterm deliveries (PTD) and very PTD. Adjustment for individual and neighbourhood-level markers of socio-economic status (SES) attenuated all the associations. Strongest associations were observed during the first and second trimesters. Cross-sectional associations for mean greenness were similar with narrower CIs, and associations with NDVI were stronger than with tree cover and stronger for mean compared with variance of greenness. Associations were consistent for term births, different buffer sizes and for further adjustment to maternal education. Stronger associations were observed for lowest SES. Distance to ‘outdoor gyms’ and variance of greenness had the largest estimates of mediation.
Conclusion
This study adds to the limited information on when exposure to greenness is most beneficial, on the association with variance of greenness and the possible pathways. These observations require confirmation in other populations.
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Affiliation(s)
- Keren Agay-Shay
- Department of Population Health, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Yaron Michael
- Department of Geography and Environment, Bar Ilan University, Ramat-Gan, Israel
| | - Xavier Basagaña
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Èrica Martínez-Solanas
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - David Broday
- Department of Environmental, Water, and Agricultural Engineering, Faculty of Civil and Environmental Engineering, Technion—Israel Institute of Technology, Haifa, Israel
| | - Itamar M Lensky
- Department of Geography and Environment, Bar Ilan University, Ramat-Gan, Israel
| | - Mary Rudolf
- Department of Population Health, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Lisa Rubin
- Department of Maternal and Child Health, Public Health Services, Ministry of Health, Jerusalem, Israel
- School of Public Health, University of Haifa, Haifa, Israel
| | - Rafi Kent
- Department of Geography and Environment, Bar Ilan University, Ramat-Gan, Israel
| | - Nadav Levy
- Public Transport Unit, Tel Aviv Municipality, Tel Aviv, Israel
| | - Ziona Haklai
- Health Information Division, Ministry of Health, Jerusalem, Israel
| | - Itamar Grotto
- Ministry of Health, Jerusalem, Israel
- School of Public Health, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
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