Greenness, civil environment, and pregnancy outcomes: perspectives with a systematic review and meta-analysis

Abstract

Background: Various maternal conditions, especially in utero conditions and prenatal exposure to environments with air pollution and greenness, have been reviewed to address the enhancement and prevention of susceptibility to health risks, including low birthweight, preterm delivery, and preeclampsia. This study aimed to qualitatively and quantitatively investigate the associations between pregnancy outcomes and the characteristics of surrounding living environment, including greenness, air pollution, and civilization. Methods: A secondary search of the MEDLINE, EMBASE, Cochrane Library, K-eArticles, and CINAHL databases was conducted without language restrictions to identify the relevant publications from the time of inception of the databases to April 2019. Results: A total of 89 studies were identified, and 10 were included in the quantitative synthesis. The greenness of the environment within 100-, 250-and 500-m buffers, after adjusting for the air quality and civilization factors, was weakly but positively associated with birthweight. The pooled regression slope was 0.00134 (95% confidence interval [CI], 0.000, 0.0020). The greenness of the environment was also associated with a significant decrease in the incidence of poor pregnancy outcomes, namely, low birthweight, small for gestational age (odds ratio [OR] 0.94; 95% CI, 0.92, 0.97), and preterm delivery (OR 0.98; 95% CI, 0.97, 0.99). Conclusions: The greenness of the environment had a positive effect on the pregnancy outcomes, despite poor air quality and civilization. Following urbanization, planning for greenness management, environmental medicine, and public health is important and thus should be proposed as preventive methods as way of increasing birthweight and life expectancy.

Green Space Quality and Health: A Systematic Review

“…Postpartum distress was examined [ 39 ], but the effects on antenatal depression or neonatal outcomes were not investigated. This is an important topic, as the greenness of the environment was associated with reduced risks of low birth weight and preterm delivery [ 104 ].…”

Greenspace and human health: An umbrella review

“…For example, between 2014 and 2020, there have been seven published systematic reviews and meta-analyses on maternal greenness exposure and birth weight alone. 8 , 13 , 14 , 15 , 16 , 17 Such rapid updates make keeping up with the systematic reviews difficult for researchers, healthcare practitioners, and policy makers. In addition, many of the systematic reviews and meta-analyses focus on a single disease or one kind of similar health endpoints.…”

Effects of greenness on preterm birth: A national longitudinal study of 3.7 million singleton births

“… 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 Although some studies have reported a protective effect of greenness on birth weight, conclusions for the associations between greenness and PTB were inconsistent. 15 , 16 , 17 , 18 , 19 Some investigators have attempted to determine the association between greenness and PTB. 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 Most of the studies found no associations between greenness and PTB 15 , 16 , 17 , 18 , 19 and a few studies indicated an inverse association.…”

“… 15 , 16 , 17 , 18 , 19 Some investigators have attempted to determine the association between greenness and PTB. 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 Most of the studies found no associations between greenness and PTB 15 , 16 , 17 , 18 , 19 and a few studies indicated an inverse association. 26 , 27 Currently, it remains unclear how greenness may benefit human health.…”

“…Previous studies mainly involved PTB, while limited studies focused on its subcategories. 15 , 16 , 17 , 18 , 19 The subcategories of PTB (20–36 weeks) are categorized as extremely PTB (EPTB, 20–27 weeks), very PTB (VPTB, 28–31 weeks), and moderate to late PTB (MPTB, 32–36 weeks). 1 , 30 There is a large gap in the survival rates of these subcategories, and EPTB and VPTB are more vulnerable than MPTB.…”