{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:25:13Z","timestamp":1790691913241,"version":"4.1.0"},"reference-count":92,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2020,6,23]],"date-time":"2020-06-23T00:00:00Z","timestamp":1592870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Diputaci\u00f3n Foral de Gipuzkoa (the Gipuzkoan Provincial Council)","award":["105\/19"],"award-info":[{"award-number":["105\/19"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Residential greenness may positively impact diverse human health indicators through the reduction of air pollution, the improvement of psychological health, and the promotion of physical activity. Previous studies indicate a weak but positive association with pregnancy outcomes. Our aim was to test the multiple pathways from residential greenness to pregnancy outcomes model, using residential NO2 concentrations, psychological health, and moderate-to-vigorous physical activity (MVPA) during the first trimester of pregnancy, in a sample of 440 pregnant women residing in Donostia, Spain. Three metrics of residential greenness were calculated around each participant\u2019s home address: normalized difference vegetation index (NDVI) within 300 m, and green space (&gt;5000 m2) availability within 300 and 500 m. Residential NO2 concentrations, psychological health, and MVPA were explored as mediators of the associations between these metrics and the following pregnancy outcomes: birth weight (BW), low birth weight (LBW), prematurity, small for gestational age (SGA), and large for gestational age (LGA). Educational attainment, parity, and body mass index (BMI) were treated as covariates. Counterfactual mediation analyses showed very low to null statistical support for an association between any of the greenspace metrics and pregnancy outcomes in the full sample. Green space availability (300 m) was associated with lower BW and showed a marginal protective effect against LGA.<\/jats:p>","DOI":"10.3390\/ijerph17124520","type":"journal-article","created":{"date-parts":[[2020,6,24]],"date-time":"2020-06-24T07:14:19Z","timestamp":1592982859000},"page":"4520","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Testing the Multiple Pathways of Residential Greenness to Pregnancy Outcomes Model in a Sample of Pregnant Women in the Metropolitan Area of Donostia-San Sebasti\u00e1n"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9142-0419","authenticated-orcid":false,"given":"Asier","family":"Anabitarte","sequence":"first","affiliation":[{"name":"Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian 20014, Spain"},{"name":"Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV\/EHU), Leioa 48940, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikel","family":"Subiza-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian 20014, Spain"},{"name":"Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid 28029, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6933-5373","authenticated-orcid":false,"given":"Jes\u00fas","family":"Ibarluzea","sequence":"additional","affiliation":[{"name":"Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian 20014, Spain"},{"name":"Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid 28029, Spain"},{"name":"Faculty of Psychology of the University of the Basque Country, San Sebastian 20018, Spain"},{"name":"Health Department of the Basque Government, Sub-directorate of Public Health of Gipuzkoa, San Sebastian 20013, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kepa","family":"Azkona","sequence":"additional","affiliation":[{"name":"Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian 20014, Spain"},{"name":"Department of Geography, Prehistory and Archaeology, University of the Basque Country, Vitoria 01006, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6550-1584","authenticated-orcid":false,"given":"Gonzalo","family":"Garc\u00eda-Baquero","sequence":"additional","affiliation":[{"name":"Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian 20014, Spain"},{"name":"Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid 28029, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carme","family":"Miralles-Guasch","sequence":"additional","affiliation":[{"name":"Geography Department, Autonomous University of Barcelona, Cerdanyola del Vall\u00e8s 08193, Spain"},{"name":"Institute of Environmental Science and Technology (ICTA), Autonomous University of Barcelona, Cerdanyola del Vall\u00e8s, Barcelona 08193, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6763-8602","authenticated-orcid":false,"given":"Jon","family":"Irazusta","sequence":"additional","affiliation":[{"name":"Department of Physiology, Faculty of Medicine, University of the Basque Country (UPV\/EHU), Leioa 48940, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina W.","family":"Whitworth","sequence":"additional","affiliation":[{"name":"Center for Precision Environmental Health, Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6419-1913","authenticated-orcid":false,"given":"Guillem","family":"Vich","sequence":"additional","affiliation":[{"name":"Geography Department, Autonomous University of Barcelona, Cerdanyola del Vall\u00e8s 08193, Spain"},{"name":"ISGlobal (Barcelona Institute for Global Health), Barcelona 08036, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aitana","family":"Lertxundi","sequence":"additional","affiliation":[{"name":"Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian 20014, Spain"},{"name":"Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV\/EHU), Leioa 48940, Spain"},{"name":"Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid 28029, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,6,23]]},"reference":[{"key":"ref_1","unstructured":"Whorld Health Organization (WHO) (2005). 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