North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC 28801, USA.
NOAA's National Centers for Environmental Information (NCEI), 151 Patton Avenue, Asheville, NC 28801, USA.
Sci Total Environ. 2022 Feb 20;808:152145. doi: 10.1016/j.scitotenv.2021.152145. Epub 2021 Dec 3.
Greenspace may positively impact pregnancy health for racially and economically minoritized populations; few studies have examined local availability and accessibility of green/park space in reducing maternal morbidity. The objective of this retrospective birth cohort study was to examine the association between residential exposure to greenspace and adverse pregnancy health outcomes in a Southern US state characterized by high poverty and racial disparities in maternal health (2013-2017). National data from the Protected Area database - United States (PAD-US) and ParkServe estimated three publicly available and accessible residential greenspace measures-a more direct proxy than using remotely-sensed greenness indicators (e.g., normalized difference vegetation index (NDVI))-(a) percent area of greenspace (M1), (b) area of available greenspace per person (M2), (c) total population within a 10-minute walk (M3). Generalized Estimating Equations with logistic regression were used to examine the association between individual greenspace metrics and South Carolina hospital deliveries (n = 238,922 deliveries) for women with correlated maternal health outcomes for gestational hypertension (GHTN), gestational diabetes (GD), severe maternal morbidity (SMM), preeclampsia (PRE), mental disorders (MD), depressive disorders (DD), and preterm birth (PTB). Lowest compared to highest tertiles of all three metrics were associated with increased risk for MD, DD, and a monotonic increase in GD, particularly for black women. Women with the lowest access to M2 and M3 were more at risk for PRE, PTB, and MD. We observed that women in low-income, majority-black communities in the lowest versus highest tertile of M2 were more likely to experience a DD, MD, SMM, or PTB compared to primarily high-income majority-white communities. Available and accessible green/park space may present as an effective nature-based intervention to reduce maternal complications, particularly for gestational diabetes and other pregnancy health risks for which there are currently few known evidence-based primary prevention strategies.
绿地可能会对少数族裔和经济地位较低的人群的怀孕健康产生积极影响；很少有研究调查过绿色/公园空间的当地可用性和可及性在降低产妇发病率方面的作用。本回顾性出生队列研究的目的是在美国南部一个以贫困和孕产妇健康方面的种族差异为特征的州（2013-2017 年），检验住宅绿地暴露与不良妊娠健康结果之间的关系。来自保护地数据库-美国（PAD-US）和 ParkServe 的国家数据估计了三种公共的、可及的住宅绿地衡量标准-比使用遥感绿色指标（例如归一化差异植被指数（NDVI））更直接的指标-(a)绿地面积百分比（M1），(b)每人可利用的绿地面积（M2），(c)10 分钟步行范围内的总人口（M3）。使用广义估计方程和逻辑回归检验了个体绿地指标与南卡罗来纳州医院分娩之间的关系（n=238922 例分娩），这些分娩与孕妇相关的健康结果相关，包括妊娠高血压（GHTN）、妊娠糖尿病（GD）、严重产妇发病率（SMM）、子痫前期（PRE）、精神障碍（MD）、抑郁障碍（DD）和早产（PTB）。与所有三个指标的最高三分位数相比，最低三分位数与 MD、DD 和 GD 的风险增加呈正相关，特别是对于黑人女性。M2 和 M3 可及性最低的女性患 PRE、PTB 和 MD 的风险更高。我们观察到，与主要为高收入白人社区相比，M2 最低三分位数的低收入、多数黑人社区的女性更有可能经历 DD、MD、SMM 或 PTB。现有的、可及的绿色/公园空间可能成为一种有效的基于自然的干预措施，以降低产妇并发症的风险，特别是对于目前几乎没有已知的基于证据的初级预防策略的妊娠糖尿病和其他妊娠健康风险。
