Choi Hayon Michelle, Huybrechts Krista F, Hernandez-Diaz Sonia, Qiu Xinye, Leung Michael, James Peter, Shupler Matthew, Huang Wanyu, Wei Yaguang, Zanobetti Antonella, McDougle Christopher J, Schwartz Joel, Coull Brent, Weisskopf Marc, Papatheodorou Stefania
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA.
Environ Int. 2025 Aug;202:109666. doi: 10.1016/j.envint.2025.109666. Epub 2025 Jul 5.
Exposure to green space is associated with children's mental health, but its impact on neurodevelopment has been underexplored, especially in socioeconomically disadvantaged populations. This study examined the link between exposure to green space before, during, and after pregnancy and neurodevelopmental delays in children enrolled in Medicaid.
This cohort study of 1,841,915 mother-child pairs used data from the Medicaid Analytic Extract (MAX) from 2001 to 2014, with up to 14 years of follow-up. The population of pregnant women enrolled in Medicaid is characterized by younger age, racial and ethnic diversity, lower income levels, and includes individuals with disabilities. Green space exposure was measured using the Normalized Difference Vegetation Index (NDVI) at the maternal residential zip code level. We examined exposure to green space during the preconception, prenatal, and postnatal periods to capture critical developmental windows both separately and with mutual adjustment. Neurodevelopmental outcomes were identified using validated algorithms and included autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), learning disabilities, speech and language disorders, coordination disorders, intellectual disabilities, and behavioral disorders. We applied a stratified Cox model accounting for individual and area-level confounders and examined effect measure modification by urbanicity, child's race/ethnicity, and sex.
The study found protective associations between green space exposure and most neurodevelopmental disorders. The strongest associations were seen for preconception exposure and intellectual disability (HR 0.66 [95 % CI: 0.48-0.95]), pregnancy exposure and ASD (HR 0.83 [95 % CI: 0.73-0.95]), and postnatal exposure for learning difficulties (HR 0.81 [95 % CI: 0.68-0.97]) per interquartile range (IQR = 0.12) increase in NDVI. The protective effects were stronger for Black/Hispanic children and for those living in urban areas.
Green space exposure could benefit the children's neurodevelopment, with more significant benefits for the Black and Hispanic populations.
National Institute of Environmental Health Sciences R01-ES034038.
接触绿地与儿童心理健康相关，但其对神经发育的影响尚未得到充分研究，尤其是在社会经济地位不利的人群中。本研究调查了孕期前后接触绿地与参加医疗补助计划儿童神经发育迟缓之间的联系。
这项队列研究纳入了1,841,915对母婴，使用了2001年至2014年医疗补助分析提取物（MAX）的数据，随访时间长达14年。参加医疗补助计划的孕妇群体具有年龄较小、种族和民族多样化、收入水平较低的特点，且包括残疾个体。在母亲居住邮政编码层面，使用归一化植被指数（NDVI）测量绿地接触情况。我们分别并相互调整地研究了孕前、孕期和产后接触绿地的情况，以捕捉关键发育窗口。使用经过验证的算法确定神经发育结局，包括自闭症谱系障碍（ASD）、注意力缺陷多动障碍（ADHD）、学习障碍、言语和语言障碍、协调障碍、智力障碍和行为障碍。我们应用了分层Cox模型，考虑个体和地区层面的混杂因素，并研究了城市化程度、儿童种族/民族和性别的效应测量修正情况。
研究发现绿地接触与大多数神经发育障碍之间存在保护关联。每增加一个四分位数间距（IQR = 0.12）的NDVI，孕前接触与智力障碍（HR 0.66 [95% CI：0.48 - 0.95]）、孕期接触与ASD（HR 0.83 [95% CI：0.73 - 0.95]）以及产后接触与学习困难（HR 0.81 [95% CI：0.68 - 0.97]）之间的关联最强。对黑人/西班牙裔儿童以及居住在城市地区的儿童，保护作用更强。
接触绿地可能有益于儿童神经发育，对黑人和西班牙裔人群的益处更为显著。
美国国立环境卫生科学研究所R01 - ES034038。
