TY - JOUR
T1 - Mean and variance of greenness and pregnancy outcomes in Tel Aviv during 2000-14
T2 - Longitudinal and cross-sectional approaches
AU - Agay-Shay, Keren
AU - Michael, Yaron
AU - Basagaña, Xavier
AU - Martínez-Solanas, Èrica
AU - Broday, David
AU - Lensky, Itamar M.
AU - Rudolf, Mary
AU - Rubin, Lisa
AU - Kent, Rafi
AU - Levy, Nadav
AU - Haklai, Ziona
AU - Grotto, Itamar
N1 - Publisher Copyright:
© 2018 The Author(s).
PY - 2019/8/1
Y1 - 2019/8/1
N2 - 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.
AB - 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.
KW - Normalised Difference Vegetation Index (NDVI)
KW - Vegetation Continuous Fields (VCF)
KW - birthweight
KW - greenness
KW - low birthweight (LBW)
KW - mediation
KW - pregnancy outcomes
KW - preterm deliveries (PTD)
KW - small for gestational age (SGA)
KW - very PTD (VPTD)
UR - http://www.scopus.com/inward/record.url?scp=85065169904&partnerID=8YFLogxK
U2 - 10.1093/ije/dyy249
DO - 10.1093/ije/dyy249
M3 - Article
C2 - 30544203
AN - SCOPUS:85065169904
SN - 0300-5771
VL - 48
SP - 1054
EP - 1072
JO - International Journal of Epidemiology
JF - International Journal of Epidemiology
IS - 4
M1 - dyy249
ER -