Racial and ethnic disparities in pregnancy complications and the protective role of greenspace: A retrospective birth cohort study

Jennifer D Runkle; Jessica L Matthews; Laurel Sparks; Leo McNicholas; Margaret M Sugg

doi:10.1016/j.scitotenv.2021.152145

Racial and ethnic disparities in pregnancy complications and the protective role of greenspace: A retrospective birth cohort study

Sci Total Environ. 2022 Feb 20:808:152145. doi: 10.1016/j.scitotenv.2021.152145. Epub 2021 Dec 3.

Authors

Jennifer D Runkle¹, Jessica L Matthews², Laurel Sparks³, Leo McNicholas⁴, Margaret M Sugg⁵

Affiliations

¹ North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC 28801, USA. Electronic address: jrrunkle@ncsu.edu.
² NOAA's National Centers for Environmental Information (NCEI), 151 Patton Avenue, Asheville, NC 28801, USA. Electronic address: jessica.matthews@noaa.gov.
³ Department of Geosciences, Georgia State University, Atlanta, GA 30303, USA.
⁴ Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
⁵ Department of Geography and Planning, Appalachian State University, P.O. Box 32066, Boone, NC 28608, USA. Electronic address: kovachmm@appstate.edu.

PMID: 34871679
DOI: 10.1016/j.scitotenv.2021.152145

Abstract

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.

Keywords: Gestational diabetes; Greenspace; Index of Concentration at the Extremes (ICE); Maternal morbidity; Pregnancy; Structural racism.

MeSH terms

Birth Cohort
Ethnicity
Female
Health Status Disparities*
Humans
Infant, Newborn
Parks, Recreational
Pregnancy
Pregnancy Complications*
Premature Birth*
Racial Groups
Retrospective Studies
United States