Causally inferred evidence of the impact of green and blue spaces (GBS) on maternal and neonatal health: a systematic review and meta-analysis
The benefits of green and blue space (GBS) exposure on improving public health are accepted by a range of stakeholders, including policy makers. Extensive GBS research into health supports the theory that GBS promotes physical activity and has mental restorative and environmental mitigative properti...
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| Format: | Article |
| Language: | English |
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IOP Publishing
2025-01-01
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| Series: | Environmental Research: Health |
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| Online Access: | https://doi.org/10.1088/2752-5309/ada8ce |
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| author | Rukun K S Khalaf Selin Akaraci Faye D Baldwin Rebecca S Geary Ruwanthi Kolamunnage-Dona Ruth F Hunter Sarah E Rodgers |
| author_facet | Rukun K S Khalaf Selin Akaraci Faye D Baldwin Rebecca S Geary Ruwanthi Kolamunnage-Dona Ruth F Hunter Sarah E Rodgers |
| author_sort | Rukun K S Khalaf |
| collection | DOAJ |
| description | The benefits of green and blue space (GBS) exposure on improving public health are accepted by a range of stakeholders, including policy makers. Extensive GBS research into health supports the theory that GBS promotes physical activity and has mental restorative and environmental mitigative properties. Studies exploring the impact of GBS exposure on maternal, prenatal, and/or neonatal health have mainly utilised cross-sectional methods. This does not allow for causal inference. Thus, our systematic review aimed to analyse the evidence of the impact of GBS on maternal, prenatal, and/or neonatal health. Our study adhered to PRISMA guidelines. We searched seven online databases (Medline, Scopus, Web of Science, PsycInfo, Embase, Environment Complete, and Maternity & Infant Care Database) and excluded cross-sectional studies without mediation analysis. Our risk of bias assessment framework was adapted from the ROBINS-E tool. We conducted narrative syntheses of studies examining maternal, prenatal, and/or neonatal outcomes. We carried out meta-analyses using random effects models for five birth outcomes (i.e. birthweight, low birthweight (LBW), gestational age, pre-term birth (PTB), and small-for-gestational-age (SGA)). Studies found to be high risk of bias, or very high risk of bias were excluded from our analyses. Initial searches yielded 1099 articles. Following full text screening, our review included 62 studies. Most studies were conducted in either Europe or North America ( n = 41, 66%). All studies reported green space exposure as an independent variable while seven studies also included blue space exposure as an independent variable. The most reported green space variable was the Normalized Difference Vegetation Index (NDVI) ( n = 46, 74%). Our meta-analyses results indicated that greater greenness is protective against LBW (OR = 0.95, 95% CI: 0.92–0.98, p = 0.002), SGA (OR = 0.95, 95% CI: 0.92–0.99, p = 0.01), PTB (OR = 0.92, 95% CI: 0.88–0.97, p = 0.001), and affects birthweight ( β = 13.02 g, 95% CI: 9.99–16.05, p < 0.0001). |
| format | Article |
| id | doaj-art-07c21cde96234ca0874d1109d02bb931 |
| institution | Kabale University |
| issn | 2752-5309 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | IOP Publishing |
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| series | Environmental Research: Health |
| spelling | doaj-art-07c21cde96234ca0874d1109d02bb9312025-01-27T10:39:54ZengIOP PublishingEnvironmental Research: Health2752-53092025-01-013101200110.1088/2752-5309/ada8ceCausally inferred evidence of the impact of green and blue spaces (GBS) on maternal and neonatal health: a systematic review and meta-analysisRukun K S Khalaf0https://orcid.org/0000-0002-7666-0617Selin Akaraci1Faye D Baldwin2https://orcid.org/0000-0002-9425-791XRebecca S Geary3https://orcid.org/0000-0003-1417-1057Ruwanthi Kolamunnage-Dona4Ruth F Hunter5https://orcid.org/0000-0001-7315-0382Sarah E Rodgers6https://orcid.org/0000-0002-4483-0845Institute of Population Health, University of Liverpool , Liverpool L69 3GF, United KingdomCentre for Public Health, Queen’s University Belfast, Royal Victoria Hospital, Institute of Clinical Sciences B , Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, United KingdomInstitute of Population Health, University of Liverpool , Liverpool L69 3GF, United KingdomInstitute of Population Health, University of Liverpool , Liverpool L69 3GF, United KingdomInstitute of Population Health, University of Liverpool , Liverpool L69 3GF, United KingdomCentre for Public Health, Queen’s University Belfast, Royal Victoria Hospital, Institute of Clinical Sciences B , Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, United KingdomInstitute of Population Health, University of Liverpool , Liverpool L69 3GF, United KingdomThe benefits of green and blue space (GBS) exposure on improving public health are accepted by a range of stakeholders, including policy makers. Extensive GBS research into health supports the theory that GBS promotes physical activity and has mental restorative and environmental mitigative properties. Studies exploring the impact of GBS exposure on maternal, prenatal, and/or neonatal health have mainly utilised cross-sectional methods. This does not allow for causal inference. Thus, our systematic review aimed to analyse the evidence of the impact of GBS on maternal, prenatal, and/or neonatal health. Our study adhered to PRISMA guidelines. We searched seven online databases (Medline, Scopus, Web of Science, PsycInfo, Embase, Environment Complete, and Maternity & Infant Care Database) and excluded cross-sectional studies without mediation analysis. Our risk of bias assessment framework was adapted from the ROBINS-E tool. We conducted narrative syntheses of studies examining maternal, prenatal, and/or neonatal outcomes. We carried out meta-analyses using random effects models for five birth outcomes (i.e. birthweight, low birthweight (LBW), gestational age, pre-term birth (PTB), and small-for-gestational-age (SGA)). Studies found to be high risk of bias, or very high risk of bias were excluded from our analyses. Initial searches yielded 1099 articles. Following full text screening, our review included 62 studies. Most studies were conducted in either Europe or North America ( n = 41, 66%). All studies reported green space exposure as an independent variable while seven studies also included blue space exposure as an independent variable. The most reported green space variable was the Normalized Difference Vegetation Index (NDVI) ( n = 46, 74%). Our meta-analyses results indicated that greater greenness is protective against LBW (OR = 0.95, 95% CI: 0.92–0.98, p = 0.002), SGA (OR = 0.95, 95% CI: 0.92–0.99, p = 0.01), PTB (OR = 0.92, 95% CI: 0.88–0.97, p = 0.001), and affects birthweight ( β = 13.02 g, 95% CI: 9.99–16.05, p < 0.0001).https://doi.org/10.1088/2752-5309/ada8cegreen spaceblue spacepregnancybirth outcomeslongitudinalmeta-analysis |
| spellingShingle | Rukun K S Khalaf Selin Akaraci Faye D Baldwin Rebecca S Geary Ruwanthi Kolamunnage-Dona Ruth F Hunter Sarah E Rodgers Causally inferred evidence of the impact of green and blue spaces (GBS) on maternal and neonatal health: a systematic review and meta-analysis Environmental Research: Health green space blue space pregnancy birth outcomes longitudinal meta-analysis |
| title | Causally inferred evidence of the impact of green and blue spaces (GBS) on maternal and neonatal health: a systematic review and meta-analysis |
| title_full | Causally inferred evidence of the impact of green and blue spaces (GBS) on maternal and neonatal health: a systematic review and meta-analysis |
| title_fullStr | Causally inferred evidence of the impact of green and blue spaces (GBS) on maternal and neonatal health: a systematic review and meta-analysis |
| title_full_unstemmed | Causally inferred evidence of the impact of green and blue spaces (GBS) on maternal and neonatal health: a systematic review and meta-analysis |
| title_short | Causally inferred evidence of the impact of green and blue spaces (GBS) on maternal and neonatal health: a systematic review and meta-analysis |
| title_sort | causally inferred evidence of the impact of green and blue spaces gbs on maternal and neonatal health a systematic review and meta analysis |
| topic | green space blue space pregnancy birth outcomes longitudinal meta-analysis |
| url | https://doi.org/10.1088/2752-5309/ada8ce |
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