Zhang Tian, Jiang Wen, Huang Yun, Wang Cuiping, Cao Jun, Qiu Wei, Huang Rong, Zhang Jun, Ye Weiping, Zhang Qingli
Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
BMC Public Health. 2025 May 8;25(1):1708. doi: 10.1186/s12889-025-22913-y.
Inconsistencies were found between residential greenness and the risk of gestational diabetes mellitus (GDM), possibly due to variations in susceptibility among populations with different characteristics. However, little is known about whether this association could be modified by population characteristics like socioeconomic status (SES). This multicenter study conducted in a dense megacity aims to clarify these associations and explore the modification effects of demographic and socioeconomic factors.
The study included 19,618 pregnant women in 20 hospitals throughout Shanghai, China, between 2015 and 2017. Multivariable logistic regression models were utilized to assess the associations of satellite-based greenness indicators [normalized difference vegetation index (NDVI) within 500 m- and 1000 m buffers] with GDM and whether demographic and socioeconomic factors modified the associations. Potential mediation effects of fine particulate matter (PM) on the associations between greenness and GDM were also explored.
During the first two trimesters of pregnancy, an increase in NDVI-500 m or NDVI-1000 m interquartile range was consistently associated with lower GDM risks, with adjusted odds ratios (aORs) and 95% confidence interval (CI) ranging from 0.82 (0.76, 0.88) to 0.90 (0.85, 0.96). Stratified analyses revealed that the health benefits of residential greenness are more pronounced during the first two trimesters among unemployed women (aOR = 0.70; 95%CI: 0.60, 0.82), those with lower education levels (aOR = 0.72; 95%CI: 0.63, 0.82), and those without medical insurance (aOR = 0.76; 95%CI: 0.69, 0.84). Mediation analysis shows that PM reduction by greenness may explain 16.4% of the inverse association between the NDVI-500 m during early pregnancy and the risk of GDM.
Our research indicates that elevated residential greenness was associated with reduced GDM risks, partly attributed to decreased PM levels. Women with lower SES experience amplified benefits from greenness. These findings highlight the significance of bolstering urban green infrastructure, particularly in communities confronting socioeconomic challenges and areas with high levels of air pollution.
研究发现居住绿地与妊娠期糖尿病（GDM）风险之间存在不一致性，这可能是由于不同特征人群易感性存在差异。然而，对于这种关联是否会受到社会经济地位（SES）等人口特征的影响，我们知之甚少。这项在人口密集的大城市开展的多中心研究旨在阐明这些关联，并探讨人口和社会经济因素的调节作用。
该研究纳入了2015年至2017年间在中国上海20家医院的19618名孕妇。采用多变量逻辑回归模型评估基于卫星的绿地指标[500米和1000米缓冲区内的归一化植被指数（NDVI）]与GDM的关联，以及人口和社会经济因素是否对这种关联产生调节作用。还探讨了细颗粒物（PM）对绿地与GDM关联的潜在中介效应。
在妊娠的前两个孕期，NDVI - 500米或NDVI - 1000米四分位数间距增加始终与较低的GDM风险相关，调整后的优势比（aORs）和95%置信区间（CI）范围为0.82（0.76，0.88）至0.90（0.85，0.96）。分层分析显示，居住绿地的健康益处在前两个孕期对失业女性（aOR = 0.70；95%CI：0.60，0.82）、教育水平较低的女性（aOR = 0.72；95%CI：0.63，0.82）和没有医疗保险的女性（aOR = 0.76；95%CI：0.69，0.84）更为显著。中介分析表明，绿地减少PM可能解释了妊娠早期NDVI - 500米与GDM风险之间负相关的16.4%。
我们的研究表明，居住绿地增加与GDM风险降低相关，部分归因于PM水平降低。社会经济地位较低的女性从绿地中获得的益处更大。这些发现凸显了加强城市绿色基础设施的重要性，特别是在面临社会经济挑战的社区和空气污染严重的地区。
