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Green spaces and adverse pregnancy outcomes
  1. Keren Agay-Shay1,2,3,
  2. Ammatzia Peled4,
  3. Antonia Valentín Crespo1,2,3,
  4. Chava Peretz5,
  5. Yona Amitai6,
  6. Shai Linn7,
  7. Michael Friger8,
  8. Mark J Nieuwenhuijsen1,2,3
  1. 1Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
  2. 2Universitat Pompeu Fabra (UPF), Barcelona, Spain
  3. 3CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
  4. 4University of Haifa, Department of Geography and Environmental Studies, Faculty of Social Sciences Haifa 31905, Israel
  5. 5Tel Aviv University, Department of Epidemiology, Faculty of Medicine, P.O.B. 39040, Ramat Aviv 69978, Israel
  6. 6Bar Ilan University, Department of Management, Ramat Gan, 52900, Israel
  7. 7Unit of Clinical Epidemiology, Rambam Medical Center, P.O. B 9602, Haifa 31096, Israel
  8. 8Ben-Gurion University of the Negev, Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, P.O.B 653 Beersheba 84105, Israel
  1. Correspondence to Dr Keren Agay-Shay, Centre for Research in Environmental Epidemiology (CREAL), Barcelona 31905, Spain; kagayshay{at}


Objective The objective of this study was to evaluate the associations between proximity to green spaces and surrounding greenness and pregnancy outcomes, such as birth weight, low birth weight (LBW), very LBW (VLBW), gestational age, preterm deliveries (PTD) and very PTD (VPTD).

Methods This study was based on 39 132 singleton live births from a registry birth cohort in Tel Aviv, Israel, during 2000–2006. Surrounding greenness was defined as the average of satellite-based Normalised Difference Vegetation Index (NDVI) in 250 m buffers and proximity to major green spaces was defined as residence within a buffer of 300 m from boundaries of a major green space (5000 m2), based on data constructed from OpenStreetMap. Linear regression (for birth weight and gestational age) and logistic regressions models (for LBW, VLBW, PTD and VPTD) were used with adjustment for relevant covariates.

Results An increase in 1 interquartile range greenness was associated with a statistically significant increase in birth weight (19.2 g 95% CI 13.3 to 25.1) and decreased risk of LBW (OR 0.84, 95% CI 0.78 to 0.90). Results for VLBW were in the same direction but were not statistically significant. In general, no associations were found for gestational age, PTD and VPTD. The findings were consistent with different buffer and green space sizes and stronger associations were observed among those of lower socioeconomic status.

Conclusions This study confirms the results of a few previous studies demonstrating an association between maternal proximity to green spaces and birth weight. Further investigation is needed into the associations with VLBW and VPTD, which has never been studied before.

  • NDVI
  • LBW
  • PTD
  • adverse pregnancy outcomes

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