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Comparative Study
. 2016 Mar 11;13(3):311.
doi: 10.3390/ijerph13030311.

Greenness and Birth Outcomes in a Range of Pennsylvania Communities

Joan A Casey  1 , Peter James  2 , Kara E Rudolph  3 , Chih-Da Wu  4 , Brian S Schwartz  5   6   7
Affiliations
Comparative Study

Greenness and Birth Outcomes in a Range of Pennsylvania Communities

Joan A Casey et al. Int J Environ Res Public Health. .

Abstract

Living in communities with more vegetation during pregnancy has been associated with higher birth weights, but fewer studies have evaluated other birth outcomes, and only one has been conducted in the Eastern United States, in regions with a broad range, including high levels, of greenness. We evaluated associations between prenatal residential greenness and birth outcomes (term birth weight, small for gestational age, preterm birth, and low 5 min Apgar score) across a range of community types using electronic health record data from 2006-2013 from the Geisinger Health System in Pennsylvania. We assigned greenness based on mother's geocoded address using the normalized difference vegetation index from satellite imagery. We used propensity scores to restrict the study population to comparable groups among those living in green vs. less-green areas. Analyses were adjusted for demographic, clinical, and environmental covariates, and stratified by community type (city, borough, and township). In cities, higher greenness (tertiles 2-3 vs. 1) was protective for both preterm (OR = 0.78, 95% CI: 0.61-0.99) and small for gestational age birth (OR = 0.73, 95% CI: 0.58-0.97), but not birth weight or Apgar score. We did not observe associations between greenness and birth outcomes in adjusted models in boroughs or townships. These results add to the evidence that greener cities might be healthier cities.

Keywords: greenness; low birth weight; machine learning; pregnancy outcome; preterm birth; propensity score; small for gestational age.

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Figures

Figure 1
Figure 1
Schematic of residential greenness measurement, which was completed by taking the average of NDVI in a 5-pixel (1250 m) radius surrounding and including the home in the three seasons preceding birth.
Figure 2
Figure 2
Distribution of greenness (NDVI) by community type.
Figure 3
Figure 3
Propensity score distributions for patients in cities comparing those with NDVI values in the 2nd and 3rd tertiles (darker green) to the 1st (lighter green). The propensity score is the predicted probability of living in tertiles 2 or 3 (NDVI > 0.43), given baseline covariates. The analysis was restricted to participants with propensity scores outside of dark grey shaded regions to ensure that those living in green and non-green environments were comparable.
Figure 4
Figure 4
Distribution of greenness (normalized difference vegetation index (NDVI)) statewide overlaid with the location of Geisinger Medical Center (GMC) and Geisinger Wyoming Valley (GWV), the delivery hospitals, and most recent home addresses of mothers who delivered at the Geisinger Health System, Pennsylvania (PA), 2006–2013.
See this image and copyright information in PMC

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