ArticleEnvironment international2020
Associations between green space and preterm birth: Windows of susceptibility and interaction with air pollution.
Article in Environment international, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 2 of them syntheses that pooled it.
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Who cites it
39 citing papers in PubMed, 2 syntheses or guidelines pooled it, 98 citations in OpenAlex.
- Residential greenness and birth outcomes: evidence for reduced low birth weight from an umbrella review and harmonized normalized difference vegetation index synthesis.Frontiers in public health · 2026Pooled it
- Climate, Health, and Urban Green Infrastructure: The Evidence Base and Implications for Urban Policy and Spatial Planning.International journal of environmental research and public health · 2025Pooled it
- Urban tree canopy fragmentation and child mortality in low- and middle-income countries.Proceedings of the National Academy of Sciences of the United States of America · 2026Article
- Associations of Pre-Pregnancy and Prenatal Outdoor Nighttime Light, Green Space and Neighbourhood Walkability With Preterm Birth: Results From Ruian Birth Cohort Study.Paediatric and perinatal epidemiology · 2026Article
- Windows of susceptibility to fine particulate matter components for fetal birth weight: a birth cohort study.BMC public health · 2026Article
- Prenatal greenness, air pollution, and birthweight: Assessing sensitive windows of exposure and sub-populations in a multi-exposure setting.Environment international · 2026Article
- Prenatal greenness exposure and the decreased risk of low birthweight and small for gestational age: modification and mediation effects of air pollution.BMC public health · 2025Article
- Plant species richness, green spaces, and preterm birth risk in urban areas.Environment international · 2025Article
- Identifying the critical windows and joint effects of greenness and particulate matter exposures for preterm birth: a retrospective study across Guangdong Province in China from 2014 to 2018.BMC public health · 2025Article
- Residential greenness and chronic obstructive pulmonary disease in a large cohort in southern China: Potential causal links, risk trajectories, and mediation pathways.Journal of advanced research · 2025Article
- Associations of prenatal exposure to residential greenspace and active living environments with cerebral palsy: A population-based cohort study in Ontario, Canada.Environmental epidemiology (Philadelphia, Pa.) · 2025Article
- Associations between short-term exposure to fine particulate matter with ischemic stroke mortality and the role of green space: a time-series study in Zibo, China.Journal of global health · 2025Article
- Does inhabitant's fertility intention respond to housing status in the urban built environment: evidence from China.Frontiers in public health · 2025Article
- Greenspace Morphology and Preterm Birth: A State-Wide Study in Georgia, United States (2001-2016).Environmental health perspectives · 2024Article
- Advancing research on greenspace and climate-sensitive adverse birth outcomes for equity and impact.Environmental epidemiology (Philadelphia, Pa.) · 2024Article
- Fine Particulate Matter, Its Constituents, and Spontaneous Preterm Birth.JAMA network open · 2024Article
- Article
- Pregnancy outcomes as related to in utero exposure to air pollution and greenness: The Life-GAP Project.Environmental epidemiology (Philadelphia, Pa.) · 2024Article
- A cohort study of the multipollutant effects of PMEnvironmental epidemiology (Philadelphia, Pa.) · 2024Article
- Measuring Greenspace in Rural Areas for Studies of Birth Outcomes: A Comparison of Street View Data and Satellite Data.GeoHealth · 2024Article
Corrections and comments
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Authors and funding
15 authors at 8 institutions in 2 countries.
Funding
Abstract
backgroundRecent studies have reported inconsistent associations between maternal residential green space and preterm birth (PTB, born < 37 completed gestational weeks). In addition, windows of susceptibility during pregnancy have not been explored and potential interactions of green space with air pollution exposures during pregnancy are still unclear.
objectivesTo evaluate the relationships between green space and PTB, identify windows of susceptibility, and explore potential interactions between green space and air pollution.
methodsBirth certificate records for all births in California (2001-2008) were obtained. The Normalized Difference Vegetation Index (NDVI) was used to characterized green space exposure. Gestational age was treated as a time-to-event outcome; Cox proportional hazard models were applied to estimate the association between green space exposure and PTB, moderately PTB (MPTB, gestational age < 35 weeks), and very PTB (VPTB, gestational age < 30 weeks), after controlling for maternal age, race/ethnicity, education, and median household income. Month-specific green space exposure was used to identify potential windows of susceptibility. Potential interactions between green space and air pollution [fine particulate matter < 2.5 µm (PM
resultsIn total, 3,753,799 eligible births were identified, including 341,123 (9.09%) PTBs, 124,631 (3.32%) MPTBs, and 22,313 (0.59%) VPTBs. A reduced risk of PTB was associated with increases in residential NDVI exposure in 250 m, 500 m, 1000 m, and 2000 m buffers. In the 2000 m buffer, the association was strongest for VPTB [adjusted hazard ratio (HR) per interquartile range increase in NDVI: 0.959, 95% confidence interval (CI): 0.942-0.976)], followed by MPTB (HR = 0.970, 95% CI: 0.962-0.978) and overall PTB (HR = 0.972, 95% CI: 0.966-0.978). For PTB, green space during the 3rd - 5th gestational months had stronger associations than those in the other time periods, especially during the 4th gestational month (NDVI 2000 m: HR = 0.970, 95% CI: 0.965-0.975). We identified consistent positive additive and multiplicative interactions between decreasing green space and higher air pollution.
conclusionThis large study found that maternal exposure to residential green space was associated with decreased risk of PTB, MPTB, and VPTB, especially in the second trimester. There is a synergistic effect between low green space and high air pollution levels on PTB, indicating that increasing exposure to green space may be more beneficial for women with higher air pollution exposures during pregnancy.
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