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

Maria Torres Toda, Demetris Avraam, Timothy James Cadman, Serena Fossati, Montserrat de Castro, Audrius Dedele, Geoffrey Donovan, Ahmed Elhakeem, Marisa Estarlich, Amanda Fernandes, Romy Gonçalves, Regina Grazuleviciene, Jennifer R. Harris, Margreet W. Harskamp-van Ginkel, Barbara Heude, Jesús Ibarluzea, Carmen Iñiguez, Vincent WV Jaddoe, Deborah Lawlor, Aitana LertxundiJohanna Lepeule, Rosemary McEachan, Giovenale Moirano, Johanna LT Nader, Anne Marie Nybo Andersen, Marie Pedersen, Costanza Pizzi, Theano Roumeliotaki, Susana Santos, Jordi Sunyer, Tiffany Yang, Marina Vafeiadi, Tanja GM Vrijkotte, Mark Nieuwenhuijsen, Martine Vrijheid, Maria Foraster, Payam Dadvand*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

14 Citations (Scopus)
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Research 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.

Original languageEnglish
Article number107648
JournalEnvironment international
Publication statusPublished - Dec 2022

Bibliographical note

Funding Information:
This project received funding from the European Union's Horizon 2020 research and innovation programme (LIFECYCLE, grant agreement No 733206; EUCAN-Connect grant agreement No 824989). ISGlobal acknowledges support from the Spanish Ministry of Science and Innovation and State Research Agency through the “Centro de Excelencia Severo Ochoa 2019-2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program. For more information of each cohort individual funding, see Supplementary Material s, Information S2.

Publisher Copyright:
© 2022


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