Abstract
An association between green space exposure and preterm birth has been reported. However, evidence on the joint effects of air pollutant and green space exposure on preterm birth from nationwide research is limited in China. Based on a nationwide cohort, this study aims to explore the effect of green space exposure on preterm birth and analyze the joint effects of green space and air pollutant. Logistic regression models were developed to analyze the effects of green space exposure, and interaction effects were evaluated by adding interaction terms between green space and air pollutants. From 2013 to 2019, this study included 2,294,188 records of newborn births, of which 82,921 were preterm births. The results show that for buffer zones with 250 m, 500 m, 1000 m, and 1500 m, every 0.1 unit increase in NDVI exposure was associated with a decrease in the risk of preterm birth by 5.5% (95% CI: 4.6–6.4%), 5.8% (95% CI: 4.9–6.6%), 6.1% (95% CI: 5.3–7.0%), and 5.6% (95% CI: 4.7–6.5%), respectively. Under high-level exposure to air pollutants, high-level NDVI exposure was more strongly negatively correlated with preterm birth than low-level NDVI exposure. High-level green space exposure might mitigate the adverse effect of air pollutants on preterm birth by promoting physical activity, reducing stress, and adsorbing pollutants. Further investigation is needed to explore how green space and air pollution interact and affect preterm birth, in order to improve risk management and provide a reference for newborn health.
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References
Abelt K, McLafferty S (2017) Green streets: urban green and birth outcomes. Int J Environ Res Public Health 14:771. https://doi.org/10.3390/ijerph14070771
Agay-Shay K, Peled A, Crespo AV, Peretz C, Amitai Y, Linn S, Friger M, Nieuwenhuijsen MJ (2014) Green spaces and adverse pregnancy outcomes. Occup Environ Med 71:562–569. https://doi.org/10.1136/oemed-2013-101961
Astell-Burt T, Feng X (2019) Association of urban green space with mental health and general health among adults in Australia. JAMA Netw Open 2:e198209. https://doi.org/10.1001/jamanetworkopen.2019.8209
Aune D, Schlesinger S, Henriksen T, Saugstad OD, Tonstad S (2017) Physical activity and the risk of preterm birth: a systematic review and meta-analysis of epidemiological studies. BJOG 124:1816–1826. https://doi.org/10.1111/1471-0528.14672
Banay Rachel F, James P, Hart Jaime E, Kubzansky Laura D, Spiegelman D, Okereke Olivia I, Spengler John D, Laden F (2019) Greenness and depression incidence among older women. Environ Health Perspect 127:027001. https://doi.org/10.1289/EHP1229
Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller A-B, Kinney M, Lawn J, the Born Too Soon Preterm Birth Action G (2013) Born too soon: the global epidemiology of 15 million preterm births. Reprod Health 10:S2. https://doi.org/10.1186/1742-4755-10-S1-S2
Chen H, Burnett Richard T, Bai L, Kwong Jeffrey C, Crouse Dan L, Lavigne E, Goldberg Mark S, Copes R, Benmarhnia T, Ilango Sindana D, van Donkelaar A, Martin Randall V, Hystad P (2020) Residential greenness and cardiovascular disease incidence, readmission, and mortality. Environ Health Perspect 128:087005. https://doi.org/10.1289/EHP6161
Dadvand P, de Nazelle A, Figueras F, Basagaña X, Su J, Amoly E, Jerrett M, Vrijheid M, Sunyer J, Nieuwenhuijsen MJ (2012a) Green space, health inequality and pregnancy. Environ Int 40:110–115. https://doi.org/10.1016/j.envint.2011.07.004
Dadvand P, Sunyer J, Basagaña X, Ballester F, Lertxundi A, Fernández-Somoano A, Estarlich M, García-Esteban R, Mendez Michelle A, Nieuwenhuijsen Mark J (2012b) Surrounding greenness and pregnancy outcomes in four Spanish birth cohorts. Environ Health Perspect 120:1481–1487. https://doi.org/10.1289/ehp.1205244
Dai L, Zhu J, Liang J, Wang Y-P, Wang H, Mao M (2011) Birth defects surveillance in China. World J Pediatr 7:302–310. https://doi.org/10.1007/s12519-011-0326-0
Dai L, Deng C, Li Y, Zhu J, Mu Y, Deng Y, Mao M, Wang Y, Li Q, Ma S, Ma X, Zhang Y (2014) Birth weight reference percentiles for Chinese. PLoS ONE 9:e104779. https://doi.org/10.1371/journal.pone.0104779
Diener A, Mudu P (2021) How can vegetation protect us from air pollution? A critical review on green spaces’ mitigation abilities for air-borne particles from a public health perspective - with implications for urban planning. Sci Total Environ 796:148605. https://doi.org/10.1016/j.scitotenv.2021.148605
Fernandez de Gamarra-Oca L, Ojeda N, Gomez-Gastiasoro A, Pena J, Ibarretxe-Bilbao N, Garcia-Guerrero MA, Loureiro B, Zubiaurre-Elorza L (2021) Long-term neurodevelopmental outcomes after moderate and late preterm birth: a systematic review. J Pediatr 237(168–176):e111. https://doi.org/10.1016/j.jpeds.2021.06.004
Gat R, Kachko E, Kloog I, Erez O, Yitshak-Sade M, Novack V, Novack L (2021) Differences in environmental factors contributing to preterm labor and PPROM – population based study. Environ Res 196:110894. https://doi.org/10.1016/j.envres.2021.110894
Glazer KB, Eliot MN, Danilack VA, Carlson L, Phipps MG, Dadvand P, Savitz DA, Wellenius GA (2018) Residential green space and birth outcomes in a coastal setting. Environ Res 163:97–107. https://doi.org/10.1016/j.envres.2018.01.006
Godfrey R, Julien M (2005) Urbanisation and health. Clin Med 5:137–141
Grazuleviciene R, Danileviciute A, Dedele A, Vencloviene J, Andrusaityte S, Uždanaviciute I, Nieuwenhuijsen MJ (2015) Surrounding greenness, proximity to city parks and pregnancy outcomes in Kaunas cohort study. Int J Hyg Environ Health 218:358–365. https://doi.org/10.1016/j.ijheh.2015.02.004
Han Y, Jiang P, Dong T, Ding X, Chen T, Villanger GD, Aase H, Huang L, Xia Y (2018) Maternal air pollution exposure and preterm birth in Wuxi, China: effect modification by maternal age. Ecotoxicol Environ Saf 157:457–462. https://doi.org/10.1016/j.ecoenv.2018.04.002
He Y, Jiang Y, Wang Y, Yang Y, Xu JH, Zhang Y, Wang Q, Shen H, Zhang Y, Yan D, Peng Z, Liu C, Wang W, Schikowski T, Li H, Yan B, Ji J, Chen A, van Donkelaar A, Martin R, Chen R, Kan H, Cai J, Ma X (2022) Composition of fine particulate matter and risk of preterm birth: a nationwide birth cohort study in 336 Chinese cities. J Hazard Mater 425:127645. https://doi.org/10.1016/j.jhazmat.2021.127645
Hubert-Moy L, Thibault J, Fabre E, Rozo C, Arvor D, Corpetti T, Rapinel S (2019) Time-series spectral dataset for croplands in France (2006–2017). Data Brief 27:104810. https://doi.org/10.1016/j.dib.2019.104810
Johnston KM, Gooch K, Korol E (2014) The economic burden of prematurity in Canada. BMC Pediatr 14:93. https://doi.org/10.1186/1471-2431-14-93
Ju L, Li C, Yang M, Sun S, Zhang Q, Cao J, Ding R (2021) Maternal air pollution exposure increases the risk of preterm birth: evidence from the meta-analysis of cohort studies. Environ Res 202:111654. https://doi.org/10.1016/j.envres.2021.111654
Ju L, Hua L, Xu H, Li C, Sun S, Zhang Q, Cao J, Ding R (2023) Maternal atmospheric particulate matter exposure and risk of adverse pregnancy outcomes: a meta-analysis of cohort studies. Environ Pollut 317:120704. https://doi.org/10.1016/j.envpol.2022.120704
Keil Alexander P, Buckley Jessie P, O’Brien Katie M, Ferguson Kelly K, Zhao S, White Alexandra J (2020) A quantile-based g-computation approach to addressing the effects of exposure mixtures. Environ Health Perspect 128:047004. https://doi.org/10.1289/EHP5838
Laurent O, Wu J, Li L, Milesi C (2013) Green spaces and pregnancy outcomes in Southern California. Health Place 24:190–195. https://doi.org/10.1016/j.healthplace.2013.09.016
Lee P-C, Wu C-D, Tsai H-J, Tsai H-Y, Lin S-H, Wu C-K, Hung C-Y, Yao T-C (2021) Residential greenness and birth outcomes: evaluating the mediation and interaction effects of particulate air pollution. Ecotoxicol Environ Saf 211:111915. https://doi.org/10.1016/j.ecoenv.2021.111915
Liu D, Di B, Luo Y, Deng X, Zhang H, Yang F, Grieneisen ML, Zhan Y (2019) Estimating ground-level CO concentrations across China based on the national monitoring network and MOPITT: potentially overlooked CO hotspots in the Tibetan Plateau. Atmos Chem Phys 19:12413–12430. https://doi.org/10.5194/acp-19-12413-2019
Malley CS, Kuylenstierna JCI, Vallack HW, Henze DK, Blencowe H, Ashmore MR (2017) Preterm birth associated with maternal fine particulate matter exposure: a global, regional and national assessment. Environ Int 101:173–182. https://doi.org/10.1016/j.envint.2017.01.023
Margerison CE, Pearson AL, Lin Z, Sanciangco J (2020) Changes in residential greenness between pregnancies and birth outcomes: longitudinal evidence from Michigan births 1990–2012. Int J Epidemiol 50:190–198. https://doi.org/10.1093/ije/dyaa158
Markevych I, Schoierer J, Hartig T, Chudnovsky A, Hystad P, Dzhambov AM, de Vries S, Triguero-Mas M, Brauer M, Nieuwenhuijsen MJ, Lupp G, Richardson EA, Astell-Burt T, Dimitrova D, Feng X, Sadeh M, Standl M, Heinrich J, Fuertes E (2017) Exploring pathways linking greenspace to health: theoretical and methodological guidance. Environ Res 158:301–317. https://doi.org/10.1016/j.envres.2017.06.028
Nowak DJ, Crane DE, Stevens JC (2006) Air pollution removal by urban trees and shrubs in the United States. Urban Urban Green 4:115–123. https://doi.org/10.1016/j.ufug.2006.01.007
Qiu Z, Li W, Qiu Y, Chen Z, Yang F, Xu W, Gao Y, Liu Z, Li Q, Jiang M, Liu H, Zhan Y, Dai L (2023) Third trimester as the susceptibility window for maternal PM(2.5) exposure and preterm birth: a nationwide surveillance-based association study in China. Sci Total Environ 880:163274. https://doi.org/10.1016/j.scitotenv.2023.163274
Saigal S, Doyle LW (2008) An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 371:261–269. https://doi.org/10.1016/s0140-6736(08)60136-1
Sarkar C, Zhang B, Ni M, Kumari S, Bauermeister S, Gallacher J, Webster C (2019) Environmental correlates of chronic obstructive pulmonary disease in 96 779 participants from the UK Biobank: a cross-sectional, observational study. Lancet Planet Health 3:e478–e490. https://doi.org/10.1016/S2542-5196(19)30214-1
Smith RB, Beevers SD, Gulliver J, Dajnak D, Fecht D, Blangiardo M, Douglass M, Hansell AL, Anderson HR, Kelly FJ, Toledano MB (2020) Impacts of air pollution and noise on risk of preterm birth and stillbirth in London. Environ Int 134:105290. https://doi.org/10.1016/j.envint.2019.105290
Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, Howard LM, Pariante CM (2014) Effects of perinatal mental disorders on the fetus and child. Lancet 384:1800–1819. https://doi.org/10.1016/S0140-6736(14)61277-0
Sun Y, Ilango SD, Schwarz L, Wang Q, Chen J-C, Lawrence JM, Wu J, Benmarhnia T (2020a) Examining the joint effects of heatwaves, air pollution, and green space on the risk of preterm birth in California. Environ Res Lett 15:104099. https://doi.org/10.1088/1748-9326/abb8a3
Sun Y, Sheridan P, Laurent O, Li J, Sacks DA, Fischer H, Qiu Y, Jiang Y, Yim IS, Jiang LH, Molitor J, Chen JC, Benmarhnia T, Lawrence JM, Wu J (2020b) Associations between green space and preterm birth: windows of susceptibility and interaction with air pollution. Environ Int 142:105804. https://doi.org/10.1016/j.envint.2020.105804
Tarquini F, Picchiassi E, Coata G, Centra M, Bini V, Meniconi S, Antonelli C, Giardina I, Di Renzo GC (2018) Induction of the apoptotic pathway by oxidative stress in spontaneous preterm birth: single nucleotide polymorphisms, maternal lifestyle factors and health status. Biomed Rep 9:81–89. https://doi.org/10.3892/br.2018.1103
Twohig-Bennett C, Jones A (2018) The health benefits of the great outdoors: a systematic review and meta-analysis of greenspace exposure and health outcomes. Environ Res 166:628–637. https://doi.org/10.1016/j.envres.2018.06.030
Vadillo-Ortega F, Osornio-Vargas A, Buxton MA, Sánchez BN, Rojas-Bracho L, Viveros-Alcaráz M, Castillo-Castrejón M, Beltrán-Montoya J, Brown DG, O’Neill MS (2014) Air pollution, inflammation and preterm birth: a potential mechanistic link. Med Hypotheses 82:219–224. https://doi.org/10.1016/j.mehy.2013.11.042
Wang M, Gan W, Kartsonaki C, Guo Y, Lv J, Chen Z, Li L, Yang L, Yu M (2022) Menopausal status, age at natural menopause and risk of diabetes in China: a 10-year prospective study of 300,000 women. Nutr Metab 19:7. https://doi.org/10.1186/s12986-022-00643-x
WHO (1977) Recommended definitions, Terminology and format for statistical tables related to the perinatal period and use of a new certificate for cause of perinatal deaths. Acta Obstet Gyn Scan 56:247–253. https://doi.org/10.3109/00016347709162009
WHO (2022) Preterm birth. https://www.who.int/news-room/fact-sheets/detail/preterm-birth (accessed on 26 April, 2023)
Willis Mary D, Wesselink Amelia K, Hystad P, Pescador Jimenez M, Coleman Chad M, Kirwa K, Hatch Elizabeth E, Wise Lauren A (2023) Associations between residential greenspace and fecundability in a North American preconception cohort study. Environ Health Perspect 131:047012. https://doi.org/10.1289/EHP10648
Wood SN (2017) Generalized additive models: an introduction with R. Taylor and Francis CRC Press, New York
Wu Y, Di B, Luo Y, Grieneisen ML, Zeng W, Zhang S, Deng X, Tang Y, Shi G, Yang F, Zhan Y (2021) A robust approach to deriving long-term daily surface NO2 levels across China: correction to substantial estimation bias in back-extrapolation. Environ Int 154:106576. https://doi.org/10.1016/j.envint.2021.106576
Xiao X, Gao M, Zhou Y, Xu SL, Knibbs LD, Heinrich J, Dharmage SC, Morawska L, Lin S, Jalaludin B, Shen X, Zhou Y, Dong GH (2022) Is greener better? Associations between greenness and birth outcomes in both urban and non-urban settings. Int J Epidemiol 51:88–98. https://doi.org/10.1093/ije/dyab164
Yang B-Y, Zhao T, Hu L-X, Browning MHEM, Heinrich J, Dharmage SC, Jalaludin B, Knibbs LD, Liu X-X, Luo Y-N, James P, Li S, Huang W-Z, Chen G, Zeng X-W, Hu L-W, Yu Y, Dong G-H (2021) Greenspace and human health: an umbrella review. Innov 2:100164. https://doi.org/10.1016/j.xinn.2021.100164
Ye T, Zhang Y, Chen G, Yang Z, Guo Y, Abramson MJ, Li S (2023) Associations between neighborhood greenspace and multiple birth outcomes across two metropolitan areas in Australia. Sci Total Environ 891:164647. https://doi.org/10.1016/j.scitotenv.2023.164647
Ye T, Xu R, Abramson MJ, Guo Y, Zhang Y, Saldiva PHN, Coelho MSZS, Li S (2024) Maternal greenness exposure and preterm birth in Brazil: a nationwide birth cohort study. Environ Pollut 343:123156. https://doi.org/10.1016/j.envpol.2023.123156
Zhan Y, Luo Y, Deng X, Chen H, Grieneisen ML, Shen X, Zhu L, Zhang M (2017) Spatiotemporal prediction of continuous daily PM2.5 concentrations across China using a spatially explicit machine learning algorithm. Atmos Environ 155:129–139. https://doi.org/10.1016/j.atmosenv.2017.02.023
Zhan Y, Luo Y, Deng X, Grieneisen ML, Zhang M, Di B (2018) Spatiotemporal prediction of daily ambient ozone levels across China using random forest for human exposure assessment. Environ Pollut 233:464–473. https://doi.org/10.1016/j.envpol.2017.10.029
Zhang H, Di B, Liu D, Li J, Zhan Y (2019) Spatiotemporal distributions of ambient SO2 across China based on satellite retrievals and ground observations: substantial decrease in human exposure during 2013–2016. Environ Res 179:108795. https://doi.org/10.1016/j.envres.2019.108795
Zhang J, Sun K, Zhang Y (2021a) The rising preterm birth rate in China: a cause for concern. Lancet Glob Health 9:e1179–e1180. https://doi.org/10.1016/S2214-109X(21)00337-5
Zhang Y, Mustieles V, Williams PL, Wylie BJ, Souter I, Calafat AM, Demokritou M, Lee A, Vagios S, Hauser R, Messerlian C (2021b) Parental preconception exposure to phenol and phthalate mixtures and the risk of preterm birth. Environ Int 151:106440. https://doi.org/10.1016/j.envint.2021.106440
Zhang L, Shi S, Wu S, Yang Y, Xu J, Zhang Y, Wang Q, Shen H, Zhang Y, Yan D, Peng Z, Liu C, Wang W, Jiang Y, Shi S, Chen R, Kan H, He Y, Meng X, Ma X (2022) Effects of greenness on preterm birth: a national longitudinal study of 3.7 million singleton births. Innovation 3:100241. https://doi.org/10.1016/j.xinn.2022.100241
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The work was supported by the National Natural Science Foundation of China (22076129).
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TM and ZQ drafted the manuscript. TM, ZQ, CL, and WL performed data cleaning and statistical analyses. YG, ZC, WX, ZL, QL, and MJ provided extensive comments on this manuscript. HL, DL, and YZ designed the research plan and revised the manuscript. All authors had read and approved the final manuscript.
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Mi, T., Qiu, Z., Li, C. et al. Joint effects of green space and air pollutant exposure on preterm birth: evidence from a nationwide study in China. Environ Sci Pollut Res (2024). https://doi.org/10.1007/s11356-024-33561-x
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DOI: https://doi.org/10.1007/s11356-024-33561-x