{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:25:18Z","timestamp":1790691918614,"version":"4.1.0"},"reference-count":46,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2018,6,12]],"date-time":"2018-06-12T00:00:00Z","timestamp":1528761600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000139","name":"U.S. Environmental Protection Agency","doi-asserted-by":"publisher","award":["RD-834798"],"award-info":[{"award-number":["RD-834798"]}],"id":[{"id":"10.13039\/100000139","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000139","name":"U.S. Environmental Protection Agency","doi-asserted-by":"publisher","award":["RD-835872"],"award-info":[{"award-number":["RD-835872"]}],"id":[{"id":"10.13039\/100000139","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000139","name":"U.S. Environmental Protection Agency","doi-asserted-by":"publisher","award":["RD-83615601"],"award-info":[{"award-number":["RD-83615601"]}],"id":[{"id":"10.13039\/100000139","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["P50MD010428"],"award-info":[{"award-number":["P50MD010428"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R00CA201542"],"award-info":[{"award-number":["R00CA201542"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Natural vegetation, or greenness, may benefit maternal health and consequently, fetal growth, by providing opportunities for physical activity and psychological restoration, and decreasing detrimental environmental exposures. We retrieved Massachusetts Birth Registry data from 2001\u20132013 and investigated the association between residential greenness and birthweight in full-term births (\u226537 weeks gestation). We calculated average residential greenness during pregnancy using 250 m normalized difference vegetation index (NDVI) from satellites. We estimated associations between greenness and continuous birthweight, term low birthweight (TLBW: &lt;2500 g), and small for gestational age (SGA: &lt;10th percentile of birthweight stratified by sex and gestational age) adjusted for individual and neighborhood covariates and considered nonlinearity and effect modification. Higher greenness exposure was associated with higher birthweight with stronger associations in the lower than higher range of greenness. Greenness was associated with lower odds of TLBW (OR 0.98; 95% CI 0.97, 0.99 per 0.1 increase in NDVI) and SGA (OR 0.98; 95% 0.97, 0.99) and associations varied by population density (TLBW) and socioeconomic status (TLBW, SGA). Our results suggest that greenness is beneficial to fetal growth exhibited by higher birthweight and lower odds of TLBW and SGA. Unlike prior studies, associations with TLBW and SGA appeared stronger among those with higher socioeconomic status.<\/jats:p>","DOI":"10.3390\/ijerph15061248","type":"journal-article","created":{"date-parts":[[2018,6,12]],"date-time":"2018-06-12T10:58:32Z","timestamp":1528801112000},"page":"1248","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":57,"title":["Residential Greenness and Birthweight in the State of Massachusetts, USA"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8659-6794","authenticated-orcid":false,"given":"Kelvin C.","family":"Fong","sequence":"first","affiliation":[{"name":"Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itai","family":"Kloog","sequence":"additional","affiliation":[{"name":"Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva 653, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent A.","family":"Coull","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petros","family":"Koutrakis","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francine","family":"Laden","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"},{"name":"Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"},{"name":"Channing Division of Network Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel D.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"},{"name":"Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"James","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Belbasis, L., Savvidou, M.D., Kanu, C., Evangelou, E., and Tzoulaki, I. (2016). Birth weight in relation to health and disease in later life: An umbrella review of systematic reviews and meta-analyses. BMC Med., 14.","DOI":"10.1186\/s12916-016-0692-5"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1007\/s10995-009-0538-2","article-title":"Birth weight and health and developmental outcomes in US children, 1997\u20132005","volume":"15","author":"Boulet","year":"2011","journal-title":"Matern. Child Health J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"176","DOI":"10.2307\/1602514","article-title":"Long-term developmental outcomes of low birth weight infants","volume":"5","author":"Hack","year":"1995","journal-title":"Future Child. Cent. Future Child. David Lucile Packard Found."},{"key":"ref_4","first-page":"38","article-title":"Air pollution during pregnancy and lung development in the child","volume":"21","author":"Korten","year":"2017","journal-title":"Paediatr. Respir. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S107","DOI":"10.1111\/j.1523-1755.2005.09718.x","article-title":"Long-term consequences of low birth weight","volume":"68","author":"Reyes","year":"2005","journal-title":"Kidney Int. Suppl."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Abelt, K., and McLafferty, S. (2017). Green Streets: Urban Green and Birth Outcomes. Int. J. Environ. Res. Public. Health, 14.","DOI":"10.3390\/ijerph14070771"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Casey, J.A., James, P., Rudolph, K.E., Wu, C.-D., and Schwartz, B.S. (2016). Greenness and Birth Outcomes in a Range of Pennsylvania Communities. Int. J. Environ. Res. Public. Health, 13.","DOI":"10.3390\/ijerph13030311"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.envres.2016.10.003","article-title":"Associations between residential greenness and birth outcomes across Texas","volume":"152","author":"Cusack","year":"2017","journal-title":"Environ. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.healthplace.2017.07.002","article-title":"Associations between multiple green space measures and birth weight across two US cities","volume":"47","author":"Cusack","year":"2017","journal-title":"Health Place"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1289\/ehp.1205244","article-title":"Surrounding greenness and pregnancy outcomes in four Spanish birth cohorts","volume":"120","author":"Dadvand","year":"2012","journal-title":"Environ. Health Perspect."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1289\/ehp.1205575","article-title":"Maternal exposure to particulate air pollution and term birth weight: A multi-country evaluation of effect and heterogeneity","volume":"121","author":"Dadvand","year":"2013","journal-title":"Environ. Health Perspect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1016\/j.scitotenv.2015.10.111","article-title":"Association between greenness, urbanicity, and birth weight","volume":"542","author":"Ebisu","year":"2016","journal-title":"Sci. Total Environ."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1289\/ehp.1308049","article-title":"Residential greenness and birth outcomes: Evaluating the influence of spatially correlated built-environment factors","volume":"122","author":"Hystad","year":"2014","journal-title":"Environ. Health Perspect."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.envres.2017.06.028","article-title":"Exploring pathways linking greenspace to health: Theoretical and methodological guidance","volume":"158","author":"Markevych","year":"2017","journal-title":"Environ. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.landurbplan.2007.03.003","article-title":"Noise and well-being in urban residential environments: The potential role of perceived availability to nearby green areas","volume":"83","year":"2007","journal-title":"Landsc. Urban Plan."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ufug.2009.02.003","article-title":"Benefits and well-being perceived by people visiting green spaces in periods of heat stress","volume":"8","author":"Lafortezza","year":"2009","journal-title":"Urban For. Urban Green."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.ufug.2006.01.007","article-title":"Air pollution removal by urban trees and shrubs in the United States","volume":"4","author":"Nowak","year":"2006","journal-title":"Urban For. Urban Green."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Oliveira, J.C.D, and Epiphanio, J.C.N. (2012, January 22\u201327). Noise reduction in MODIS NDVI time series data based on spatial-temporal analysis. Proceedings of the 2012 IEEE International Geoscience and Remote Sensing Symposium, Munich, Germany.","DOI":"10.1109\/IGARSS.2012.6350807"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"075001","DOI":"10.1289\/EHP1663","article-title":"Nature Contact and Human Health: A Research Agenda","volume":"125","author":"Frumkin","year":"2017","journal-title":"Environ. Health Perspect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1146\/annurev-publhealth-032013-182443","article-title":"Nature and health","volume":"35","author":"Hartig","year":"2014","journal-title":"Annu. Rev. Public Health"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Bowler, D.E., Buyung-Ali, L.M., Knight, T.M., and Pullin, A.S. (2010). A systematic review of evidence for the added benefits to health of exposure to natural environments. BMC Public Health, 10.","DOI":"10.1186\/1471-2458-10-456"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.envres.2014.11.010","article-title":"Urban greenness and physical activity in a national survey of Canadians","volume":"137","author":"McMorris","year":"2015","journal-title":"Environ. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.puhe.2013.01.004","article-title":"Role of physical activity in the relationship between urban green space and health","volume":"127","author":"Richardson","year":"2013","journal-title":"Public Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"133","DOI":"10.2147\/IJWH.S125358","article-title":"Residential greenness: Current perspectives on its impact on maternal health and pregnancy outcomes","volume":"9","author":"Banay","year":"2017","journal-title":"Int. J. Womens Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.annepidem.2018.01.009","article-title":"The relationship between surrounding greenness in childhood and adolescence and depressive symptoms in adolescence and early adulthood","volume":"28","author":"Bezold","year":"2018","journal-title":"Ann. Epidemiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s40471-015-0043-7","article-title":"A Review of the Health Benefits of Greenness","volume":"2","author":"James","year":"2015","journal-title":"Curr. Epidemiol. Rep."},{"key":"ref_27","unstructured":"Weier, J., and Herring, D. (2016, May 20). Measuring Vegetation (NDVI & EVI). Available online: http:\/\/earthobservatory.nasa.gov\/Features\/MeasuringVegetation\/measuring_vegetation_2.php."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Kessner, D.M., Singer, J., Kalk, C.W., and Shlesinger, E.R. (1973). Chapter 2. Infant Death: An Analysis by Maternal Risk and Health Care, Institute of Medicine and National Academy of Sciences.","DOI":"10.1016\/0300-9572(73)90035-X"},{"key":"ref_29","unstructured":"U.S (2017, November 29). Census Bureau American Community Survey, 2010 5-Year Estimates, Available online: https:\/\/factfinder.census.gov."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1097\/EDE.0b013e3181f2f405","article-title":"Prenatal Exposure to Fine Particulate Matter and Birth Weight","volume":"21","author":"Bell","year":"2010","journal-title":"Epidemiol. Camb. Mass"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1289\/ehp.1002785","article-title":"Ambient air pollution and birth weight in full-term infants in Atlanta, 1994\u20132004","volume":"119","author":"Darrow","year":"2011","journal-title":"Environ. Health Perspect."},{"key":"ref_32","first-page":"40","article-title":"Using new satellite based exposure methods to study the association between pregnancy PM2.5 exposure, premature birth and birth weight in Massachusetts","volume":"11","author":"Kloog","year":"2012","journal-title":"Environ. Health Glob. Access Sci. Source"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.envres.2012.05.007","article-title":"Ambient air pollution, birth weight and preterm birth: A systematic review and meta-analysis","volume":"117","author":"Stieb","year":"2012","journal-title":"Environ. Res."},{"key":"ref_34","first-page":"38","article-title":"The associations between birth weight and exposure to fine particulate matter (PM2.5) and its chemical constituents during pregnancy: A meta-analysis","volume":"211","author":"Sun","year":"2016","journal-title":"Environ. Pollut. Barking Essex 1987"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.atmosenv.2014.07.014","article-title":"A new hybrid spatio-temporal model for estimating daily multi-year PM2.5 concentrations across northeastern USA using high resolution aerosol optical depth data","volume":"95","author":"Kloog","year":"2014","journal-title":"Atmos. Environ."},{"key":"ref_36","unstructured":"(2018, April 17). US Department of Commerce Census Bureau Geographic Areas Reference Manual: Chapter 12, Available online: https:\/\/www.census.gov\/geo\/reference\/garm.html."},{"key":"ref_37","unstructured":"R Core Team (2017). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.scitotenv.2015.03.103","article-title":"The association between greenness and traffic-related air pollution at schools","volume":"523","author":"Dadvand","year":"2015","journal-title":"Sci. Total Environ."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.ctim.2016.08.002","article-title":"Physiological and psychological responses of humans to the index of greenness of an interior space","volume":"28","author":"Choi","year":"2016","journal-title":"Complement. Ther. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.envres.2014.05.005","article-title":"Green space and mortality following ischemic stroke","volume":"133","author":"Wilker","year":"2014","journal-title":"Environ. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"67","DOI":"10.4137\/CMPed.S40070","article-title":"Intrauterine Growth Restriction: Antenatal and Postnatal Aspects","volume":"10","author":"Sharma","year":"2016","journal-title":"Clin. Med. Insights Pediatr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1136\/oemed-2013-101961","article-title":"Green spaces and adverse pregnancy outcomes","volume":"71","author":"Peled","year":"2014","journal-title":"Occup. Environ. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1158\/1055-9965.EPI-16-0925","article-title":"GPS-Based Exposure to Greenness and Walkability and Accelerometry-Based Physical Activity","volume":"26","author":"James","year":"2017","journal-title":"Cancer Epidemiol. Biomark. Prev. Publ. Am. Assoc. Cancer Res. Cosponsored Am. Soc. Prev. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.ijheh.2015.02.004","article-title":"Surrounding greenness, proximity to city parks and pregnancy outcomes in Kaunas cohort study","volume":"218","author":"Grazuleviciene","year":"2015","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.2105\/AJPH.92.7.1151","article-title":"Optimal Indicators of Socioeconomic Status for Health Research","volume":"92","author":"Duncan","year":"2002","journal-title":"Am. J. Public Health"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"816","DOI":"10.2105\/AJPH.82.6.816","article-title":"Socioeconomic status and health: How education, income, and occupation contribute to risk factors for cardiovascular disease","volume":"82","author":"Winkleby","year":"1992","journal-title":"Am. J. Public Health"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/6\/1248\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:08:23Z","timestamp":1760195303000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/6\/1248"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,12]]},"references-count":46,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2018,6]]}},"alternative-id":["ijerph15061248"],"URL":"https:\/\/doi.org\/10.3390\/ijerph15061248","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,12]]}}}