Objective To investigate the impact of greenspace exposure during pregnancy on adverse pregnancy outcomes among pregnant women in Guangxi Zhuang Autonomous Region, China.

Methods Based on the Guard Next Generation (GARDENER) Birth Cohort in Guangxi Zhuang Autonomous Region, pregnant women recruited between April 2023 and December 2024 were included. Greenspace exposure during pregnancy was assessed using the normalized difference vegetation index derived from remote sensing satellite data within different buffer distances around maternal residences. Relevant information on pregnant women and newborns was obtained from the medical records to analyze the five major adverse pregnancy outcomes: low birth weight, small for gestational age, preterm birth, macrosomia, and large for gestational age. Multivariable logistic regression models were used to analyze the association between prenatal greenspace exposure and adverse pregnancy outcomes. Stratified analyses were conducted to examine heterogeneity in the association across different population subgroups.

Results A total of 1044 pregnant women were included, with a mean age of 30±5 years. Multivariable logistic regression analysis showed that in the 500 m buffer zone, the highest greenspace exposure group (Q4) had a 4.2% lower risk of low birth weight (odds ratio OR=0.958, 95% confidence interval CI: 0.950-0.970), a 6.3% lower risk of small for gestational age (OR=0.937, 95%CI: 0.926-0.948), and a 2.2% lower risk of preterm birth (OR=0.978, 95%CI: 0.963-0.998) compared with the lowest exposure group (Q1). In the 1 000 m buffer zone, the highest greenspace exposure group (Q4) showed a 3.7% reduction in low birth weight risk (OR=0.963, 95%CI: 0.961-0.978), an 8.0% reduction in small for gestational age risk (OR=0.920, 95%CI: 0.909-0.931), and a 2.5% reduction in preterm birth risk (OR=0.975, 95%CI: 0.892-0.998) compared with the lowest exposure group(Q1). In the 250 m and 2 000 m buffer zones, only the risk of small for gestational age was reduced with higher greenspace exposure. Stratified analyses indicated that the protective effects of greenspace exposure on low birth weight, small for gestational age, and preterm birth within the 500 m and 1 000 m buffer zones varied across subgroups defined by maternal age, parity, pre-pregnancy body mass index, history of pregnancy complications, and infant sex.

Conclusion Prenatal greenspace exposure is associated with reduced risks of low birth weight, small for gestational age, and preterm birth, suggesting that increased access to greenspace during pregnancy may promote maternal and neonatal health.