Content area
Full Text
What this paper adds There is scant information about the impact of greenness on pregnancy outcomes. The associations between green spaces and very low birth weight and very preterm deliveries have never been previously reported.
This is the first study outside of USA and Europe demonstrating associations between maternal measures of greenness and birth weight, and the first study to report the association with low birth weight.
This study is a registry-based study restricted to routinely recorded information, and may not fully control for confounding and exposure misclassifications and, therefore, further investigations are needed to confirm our results.
Introduction
Adverse pregnancy outcomes are known to be associated with increased neonatal morbidity and mortality, as well as morbidity later in life. 1 Adverse pregnancy outcomes such as preterm deliveries (PTD) and low birth weight (LBW) have been previously associated with environmental exposures, and most of these studies have focused on environmental nuisance. 2 However, only a few studies considered the possible beneficial associations with environmental exposures, such as greenness and birth outcomes. 3-8
Green spaces are defined as 'land that is partly or completely covered with grass, trees, shrubs, or other vegetation. Green spaces includes parks, community gardens and cemeteries'. 9 The association between green spaces and health outcomes has been discussed in previous reviews, however; the underlying mechanisms of the beneficial effects of green spaces on health are not fully understood. 10-13 These effects might be mediated through (1) promoting physical activity, which has a well-established positive impact on health, (2) affecting emotions (mainly by decreasing negative emotions and improving psychophysiological stress, or through improving cognitive attention restoration), (3) increasing social contacts/cohesion or (4) improving environmental conditions, such as decreasing noise and air pollution levels and moderating urban heat island effects. Recently Kihal-Talantikite et al 8 proposed a detailed model on the beneficial effects of greenness on pregnancy outcomes.
In Israel, the prevalence rate of adverse pregnancy outcomes is similar to the European rates. 14 PTD was the leading cause of infant mortality during 2000-2006, 15 and very LBW (VLBW) deliveries are a substantial public health burden requiring 75 000 annual days of hospitalisation in Israel. 16 Therefore, the main aim of this study was to evaluate the association between proximity to green spaces and...