Background Preeclampsia (PE), characterized by hypertension and organ dysfunction during pregnancy, is a leading cause of maternal and fetal mortality. Residential greenness has been reported to be negatively associated with a broad range of health outcomes, such as mental illness and cardiovascular disease. However, evidence on the association between residential greenness and PE remains limited, particularly among non-European populations.
Objective This study aimed to investigate the association between residential greenness and PE among pregnant women in Japan, considering urbanization status and the timing of PE onset.
Methods This study included 21,816 pregnant women from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study, conducted in Miyagi Prefecture, Japan. Residential greenness was assessed using the Normalized Difference Vegetation Index (NDVI) values calculated from the center of each participant’s postal code area. PE was identified using a rule-based phenotyping algorithm applied to medical records. Logistic regression analyses were conducted to estimate odds ratios (ORs) and confidence intervals (CIs), adjusting for geographical variables, such as air pollution, urbanization status, area deprivation index, and individual-level confounders.
Results Moderate NDVI levels within a 200 m buffer were associated with a lower incidence of PE than low NDVI levels (OR: 0.79 [95% CI: 0.63–1.00]). High NDVI levels also suggested a negative association, but the results were not statistically significant (OR: 0.85 [95% CI: 0.64–1.14]), and no clear trend was observed (P for trend = 0.235). After adjusting for potential mediators, including psychological distress and physical activity, estimated values remained unchanged, but associations lost statistical significance. This association was primarily observed in non-urban areas and in late-onset PE.
Conclusion Moderate residential greenness was significantly associated with a lower incidence of PE compared to low residential greenness. These results suggest that moderate residential greenery is worth considering when choosing where to live during pregnancy.
Competing Interest StatementThe authors have declared no competing interest.
Funding StatementThis work was supported by the Japan Agency for Medical Research and Development (AMED), Japan (Grant Nos. JP19gk0110039, JP17km0105001, JP21tm0124005, and JP21tm0424601), and by the Endowed Department of Traffic and Medical Informatics in Disaster, Tohoku Medical Megabank Organization, Tohoku University, which is funded through a donation from East Japan Railway Company (JR East).
Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
Ethical approval was obtained from the Ethics Committee of the Tohoku Medical Megabank Organization (2013-1-103-1), and all participants provided written informed consent for study participation.
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Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
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Data AvailabilityIndividual data are available upon request from the corresponding author after approval from the Ethical Committee and the Materials and Information Distribution Review Committee of the Tohoku Medical Megabank Organization.
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