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Meta-Analysis
. 2020 Apr 24;17(8):2949.
doi: 10.3390/ijerph17082949.

A Systematic Review and Meta-Analysis of Associations between Green and Blue Spaces and Birth Outcomes

Selin Akaraci  1 , Xiaoqi Feng  1   2   3   4 , Thomas Suesse  5 , Bin Jalaludin  6 , Thomas Astell-Burt  1   3   4   7
Affiliations
Meta-Analysis

A Systematic Review and Meta-Analysis of Associations between Green and Blue Spaces and Birth Outcomes

Selin Akaraci et al. Int J Environ Res Public Health. .

Abstract

Previous studies suggest that green and blue spaces may promote several health outcomes including birth outcomes. However, no synthesis of previous work has specifically asked policy-relevant questions of how much and what type is needed in every neighborhood to elicit these benefits at the population level. A systematic review and meta-analyses were conducted to synthesize thirty-seven studies on the association between residential green and blue spaces and pregnancy outcomes. Meta-analyses were performed for birth weight (BW), small for gestational age (SGA), low birth weight (LBW) and preterm birth (PTB). Increase in residential greenness was statistically significantly associated with higher BW [β = 0.001, 95%CI: (<0.001, 0.002)] and lower odds of SGA [OR = 0.95, 95%CI: (0.92, 0.97)]. Associations between green space and LBW and PTB were as hypothesized but not statistically significant. Associations between blue spaces and pregnancy outcomes were not evident. No study explicitly examined questions of threshold, though some evidence of nonlinearity indicated that moderate amounts of green space may support more favorable pregnancy outcomes. Policy-relevant green and blue space exposures involving theory-driven thresholds warrant testing to ensure future investments in urban greening promote healthier pregnancy outcomes.

Keywords: blue space; green space; health benefits; pregnancy outcomes; urban planning.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Forest plot on the effect of residential greenness (NDVI) on birthweight (standardized regression coefficients, quality effects model). Note: ES—effect size; Q and I2—heterogeneity statistics. Horizontal lines, square and diamond symbols are indicating confidence intervals, effect estimates, and overall effect, respectively.
Figure 2
Figure 2
Forest plot on the effect of residential greenness (NDVI) on small for gestational age (odds ratios, quality effects model). Note: ES—effect size; Q and I2—heterogeneity statistics. Horizontal lines, square and diamond symbols are indicating confidence intervals, effect estimates and overall effect, respectively.
Figure 3
Figure 3
Forest plot on the effect of residential greenness (NDVI) on low birth weight (odds ratio, quality effects model). Note: ES—effect size; Q and I2—heterogeneity statistics. Horizontal lines, square and diamond symbols are indicating confidence intervals, effect estimates and overall effect, respectively.
Figure 4
Figure 4
Forest plot on the effect of residential greenness (NDVI) on preterm birth (odds ratio, quality effects model). Note: ES—effect size; Q and I2 —heterogeneity statistics. Horizontal lines, square and diamond symbols are indicating confidence intervals, effect estimates and overall effect, respectively.
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