Residential greenness and birthweight in the state of Massachusetts, USA

Kelvin C. Fong, Itai Kloog, Brent A. Coull, Petros Koutrakis, Francine Laden, Joel D. Schwartz, Peter James

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Natural vegetation, or greenness, may benefit maternal health and consequently, fetal growth, by providing opportunities for physical activity and psychological restoration, and decreasing detrimental environmental exposures. We retrieved Massachusetts Birth Registry data from 2001–2013 and investigated the association between residential greenness and birthweight in full-term births (≥37 weeks gestation). We calculated average residential greenness during pregnancy using 250 m normalized difference vegetation index (NDVI) from satellites. We estimated associations between greenness and continuous birthweight, term low birthweight (TLBW: <2500 g), and small for gestational age (SGA: <10th percentile of birthweight stratified by sex and gestational age) adjusted for individual and neighborhood covariates and considered nonlinearity and effect modification. Higher greenness exposure was associated with higher birthweight with stronger associations in the lower than higher range of greenness. Greenness was associated with lower odds of TLBW (OR 0.98; 95% CI 0.97, 0.99 per 0.1 increase in NDVI) and SGA (OR 0.98; 95% 0.97, 0.99) and associations varied by population density (TLBW) and socioeconomic status (TLBW, SGA). Our results suggest that greenness is beneficial to fetal growth exhibited by higher birthweight and lower odds of TLBW and SGA. Unlike prior studies, associations with TLBW and SGA appeared stronger among those with higher socioeconomic status.

Original languageEnglish
Article number1248
JournalInternational Journal of Environmental Research and Public Health
Issue number6
StatePublished - 12 Jun 2018


  • Birth outcomes
  • Birthweight
  • Greenness
  • Health inequities
  • Natural environment
  • Prenatal exposure

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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