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Exposure to natural environments during pregnancy and birth outcomes in 11 european birth cohorts

Lookup NU author(s): Dr Demetris AvraamORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2022Research suggests that maternal exposure to natural environments (i.e., green and blue spaces) promotes healthy fetal growth. However, the available evidence is heterogeneous across regions, with very few studies on the effects of blue spaces. This study evaluated associations between maternal exposure to natural environments and birth outcomes in 11 birth cohorts across nine European countries. This study, part of the LifeCycle project, was based on a total sample size of 69,683 newborns with harmonised data. For each participant, we calculated seven indicators of residential exposure to natural environments: surrounding greenspace in 100m, 300m, and 500m using Normalised Difference Vegetation Index (NDVI) buffers, distance to the nearest green space, accessibility to green space, distance to the nearest blue space, and accessibility to blue space. Measures of birth weight and small for gestational age (SGA) were extracted from hospital records. We used pooled linear and logistic regression models to estimate associations between exposure to the natural environment and birth outcomes, controlling for the relevant covariates. We evaluated the potential effect modification by socioeconomic status (SES) and region of Europe and the influence of ambient air pollution on the associations. In the pooled analyses, residential surrounding greenspace in 100m, 300m, and 500m buffer was associated with increased birth weight and lower odds for SGA. Higher residential distance to green space was associated with lower birth weight and higher odds for SGA. We observed close to null associations for accessibility to green space and exposure to blue space. We found stronger estimated magnitudes for those participants with lower educational levels, from more deprived areas, and living in the northern European region. Our associations did not change notably after adjustment for air pollution. These findings may support implementing policies to promote natural environments in our cities, starting in more deprived areas.

Publication metadata

Author(s): Torres Toda M, Avraam D, James Cadman T, Fossati S, de Castro M, Dedele A, Donovan G, Elhakeem A, Estarlich M, Fernandes A, Goncalves R, Grazuleviciene R, Harris JR, Harskamp-van Ginkel MW, Heude B, Ibarluzea J, Iniguez C, WV Jaddoe V, Lawlor D, Lertxundi A, Lepeule J, McEachan R, Moirano G, LT Nader J, Nybo Andersen A-M, Pedersen M, Pizzi C, Roumeliotaki T, Santos S, Sunyer J, Yang T, Vafeiadi M, GM Vrijkotte T, Nieuwenhuijsen M, Vrijheid M, Foraster M, Dadvand P

Publication type: Article

Publication status: Published

Journal: Environment International

Year: 2022

Volume: 170

Print publication date: 01/12/2022

Online publication date: 19/11/2022

Acceptance date: 18/11/2022

Date deposited: 27/06/2023

ISSN (print): 0160-4120

ISSN (electronic): 1873-6750

Publisher: Elsevier Ltd


DOI: 10.1016/j.envint.2022.107648


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Funder referenceFunder name
824989European Commission (Research Directorate General, Research Infrastructures)
Centro de Excelencia Severo Ochoa 2019-2023
European Union
Spanish Ministry of Science and Innovation and State Research Agency