Does the spatial scale of greenness matter? Evidence from pregnant women in urban Ontario, Canada
Abstract
Background: Neighbourhood greenness is associated with metabolic health, yet the spatial scale at which these associations operate remains unclear, particularly among pregnant women.
Methods: We conducted a population-based cohort study of pregnancies among women aged 19–45 years from urban communities in Ontario, Canada, using linked administrative health data. Greenness was measured using the Normalized Difference Vegetation Index (NDVI) within 250 m, 500 m, and 1000 m buffers around maternal residential dissemination areas at the time of their index pregnancy. Gestational diabetes mellitus (GDM) was identified using a validated algorithm based on hospital and outpatient records. Associations were estimated using generalized estimating equation logistic regression models accounting for clustering by mother and adjusting for maternal age, parity, immigration status, and neighbourhood income.
Results: The analytic sample included 1,924,926 pregnancies, with higher greenness levels concentrated in higher-income neighbourhoods. Higher greenness was associated with lower odds of GDM across all buffer sizes, with a clear gradient by spatial scale. Adjusted odds ratios were 0.70 (95% CI: 0.65–0.74) at 250 m, 0.78 (0.73–0.84) at 500 m, and 0.82 (0.77–0.88) at 1000 m. Associations were strongest at smaller buffers, indicating that immediate residential greenness may be most relevant for GDM risk.
Conclusions: Greenness closer to home is more strongly associated with reduced GDM risk. Proximity appears to be a key dimension of greenness exposure, as nearby environments may better support daily mobility, walkability, stress reduction, and mental well-being during pregnancy, while larger buffers may include less accessible spaces. Urban planning strategies should prioritize accessible, small-scale green infrastructure within residential neighbourhoods to enhance maternal health and well-being.
Key messages: • Greenness closer to home shows stronger associations with lower GDM risk, highlighting the importance of immediate neighbourhood environments.
• Urban planning should prioritize accessible, small-scale green spaces to support walkability, mental well-being, and maternal health during pregnancy.
Related
- Spatial and temporal scale sensitivity in NDVI-based greenness exposure assessment for Alzheimer’s disease incidence: a Miami-Dade County Medicare Cohort Study
- Women's empowerment and intimate partner violence among pregnant women in Northern Ghana: evidence from coarsened exact matching and double-selection LASSO analyses
- Maternal outcomes at mid-altitudes in anemic pregnant women: Evidence from the WOMAN-2 trial
- Association between perceived greenness and physical exercise among university students: nature connectedness as a statistical mediator and gender as a moderator
- Mobility-based greenness exposure is associated with racial inequalities in mental health in the U.S.
BibTeX
@article{haque2026does,
title = {{Does the spatial scale of greenness matter? Evidence from pregnant women in urban Ontario, Canada}},
author = {S Binte Haque and R Moineddin and B Shah and L Rosella and G Booth},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.276},
url = {https://doi.org/10.1093/eurpub/ckag169.276},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Does the spatial scale of greenness matter? Evidence from pregnant women in urban Ontario, Canada
AU - S Binte Haque
AU - R Moineddin
AU - B Shah
AU - L Rosella
AU - G Booth
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.276
UR - https://doi.org/10.1093/eurpub/ckag169.276
AB - Background: Neighbourhood greenness is associated with metabolic health, yet the spatial scale at which these associations operate remains unclear, particularly among pregnant women. Methods: We conducted a population-based cohort study of pregnancies among women aged 19–45 years from urban communities in Ontario, Canada, using linked administrative health data. Greenness was measured using the Normalized Difference Vegetation Index (NDVI) within 250 m, 500 m, and 1000 m buffers around maternal residential dissemination areas at the time of their index pregnancy. Gestational diabetes mellitus (GDM) was identified using a validated algorithm based on hospital and outpatient records. Associations were estimated using generalized estimating equation logistic regression models accounting for clustering by mother and adjusting for maternal age, parity, immigration status, and neighbourhood income. Results: The analytic sample included 1,924,926 pregnancies, with higher greenness levels concentrated in higher-income neighbourhoods. Higher greenness was associated with lower odds of GDM across all buffer sizes, with a clear gradient by spatial scale. Adjusted odds ratios were 0.70 (95% CI: 0.65–0.74) at 250 m, 0.78 (0.73–0.84) at 500 m, and 0.82 (0.77–0.88) at 1000 m. Associations were strongest at smaller buffers, indicating that immediate residential greenness may be most relevant for GDM risk. Conclusions: Greenness closer to home is more strongly associated with reduced GDM risk. Proximity appears to be a key dimension of greenness exposure, as nearby environments may better support daily mobility, walkability, stress reduction, and mental well-being during pregnancy, while larger buffers may include less accessible spaces. Urban planning strategies should prioritize accessible, small-scale green infrastructure within residential neighbourhoods to enhance maternal health and well-being. Key messages: • Greenness closer to home shows stronger associations with lower GDM risk, highlighting the importance of immediate neighbourhood environments. • Urban planning should prioritize accessible, small-scale green spaces to support walkability, mental well-being, and maternal health during pregnancy.
SN - 1101-1262
SN - 1464-360X
ER -