Association between Low Urban Neighborhood Greenness and Hypertensive Disorders of Pregnancy

Max Jordan Nguemeni Tiako; Clare McCarthy; Zachary F. Meisel; Michal A. Elovitz; Heather H. Burris; Eugenia South

doi:10.1055/s-0041-1733786

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2023; 40(11): 1185-1192
DOI: 10.1055/s-0041-1733786

Original Article

Association between Low Urban Neighborhood Greenness and Hypertensive Disorders of Pregnancy

Authors

Max Jordan Nguemeni Tiako

¹Department of Emergency Medicine, Center for Emergency Care and Policy Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

²Urban Health Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

³Yale School of Medicine, New Haven, Connecticut
Clare McCarthy

⁴Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Zachary F. Meisel

¹Department of Emergency Medicine, Center for Emergency Care and Policy Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

⁵Leonard Davis Institute of Health Economics, Wharton School of the University of Pennsylvania, Pennsylvania
Michal A. Elovitz

⁴Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Heather H. Burris

⁴Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

⁶Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Eugenia South

¹Department of Emergency Medicine, Center for Emergency Care and Policy Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

²Urban Health Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

⁵Leonard Davis Institute of Health Economics, Wharton School of the University of Pennsylvania, Pennsylvania

Abstract

Objective Urban neighborhood greenness is associated with greater cardiovascular health in the general population, and with better pregnancy and neonatal outcomes. Hypertension in pregnancy is a leading cause of maternal mortality and long-term cardiovascular morbidity and mortality in women. We sought to examine the association between greenness and hypertensive disorders of pregnancy.

Study Design This study is a secondary analysis of a prospective cohort study of 1,943 women who received prenatal care from December 2013 to December 2016 at a single, urban, and tertiary academic medical center in Philadelphia, PA. Greenness measure was quantified via residential tree canopy cover within circumferential buffers of 100- and 500-meter radii around participants' homes. Associations between greenness and hypertensive disorders of pregnancy (defined as gestational hypertension or preeclampsia) were estimated by using multilevel logistic regression accounting for maternal sociodemographic information (race-ethnicity, insurance status, and age) medical history (diabetes, body mass index, smoking history, and parity), neighborhood deprivation index, and including 1,225 Philadelphia residents for whom key exposure and outcome data were available.

Results At baseline, the participants' mean (SD) age was 27.5 (5.9) years, (range: 14–44 years). The majority of participants were non-Hispanic Black (857, 70.2%). Participants with less residential tree canopy cover were significantly more likely to have hypertensive disorders of pregnancy. The multivariable-adjusted odds ratio of hypertensive disorders of pregnancy among participants with less than 10% compared with those with greater than 30% tree canopy cover was 2.14 (95% confidence interval [CI]: 1.11–4.15) within 100-meter buffer.

Conclusion In our cohort, greenness was associated with lower hypertensive disorders of pregnancy odds. Our findings add to evidence that greenness may confer health benefits and warrant further investigations in identifying whether there is a causal pathway through which greenness may be protective against hypertensive disorders of pregnancy.

Key Points

Low residential tree canopy is associated with increased risk of hypertensive disorders of pregnancy
100-meter buffers are most sensitive in identifying associations between tree canopy and HDP risk
The role of greenness against hypertensive disorders of pregnancy should be further studied experimentally

Keywords

gestational hypertension - preeclampsia - tree canopy cover - greenness - maternal morbidity - environmental exposures - health disparities - environmental racism - urban health

Volltext

Referenzen

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