Residential greenness and hair cortisol levels during the first trimester of pregnancy

Maya Levhar, Anat Schonblum, Liat Arnon, Yaron Michael, Liat Salzer Sheelo, Michal Eisner, Eran Hadar, Israel Meizner, Arnon Wiznitzer, Aron Weller, Lee Koren, Keren Agay-Shay*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background and aim: Studies have shown that increased maternal cortisol level is associated with child adverse health outcomes. Hair cortisol (HC) is suitable for assessing long-term circulating cortisol concentration. Only two previous studies reported beneficial associations between cortisol and residential greenness during pregnancy and no study focused on the first trimester. Our aim was to evaluate the association between residential greenness and first trimester HC levels among pregnant women in Israel. Methods: Women were recruited during second and third trimesters. Hair samples were collected from the scalp and retrospective HC levels during the first trimester were quantified for 217 women. HC levels were natural log transformed and outliers were excluded. Based on geocoded birth address, small area sociodemographic status (SES) and mean residential surrounding greenness were calculated using high-resolution satellite-based Normalised Difference Vegetation Index (NDVI) data at 100, 300 and 500-m buffers in a cross-sectional approach. In addition, longitudinal exposure to mean greenness during a week preconception and during the first trimester were calculated. Missing covariates were imputed and linearity of the associations were evaluated. Generalized linear models were used to estimate the crude and adjusted associations controlled for the relevant covariates. Results: After exclusion of outliers, for 211 women, crude and adjusted beneficial associations between exposure to higher mean NDVI and HC levels were observed for all the exposure measures. An increase in 1 interquartile range of greenness (100 m buffer) was associated with a statistically significant lower estimated natural log mean HC level (−0.27 95% CI: −0.44; −0.11). The associations were robust to adjustment for covariates. The findings were consistent for different buffers, for the longitudinal approach, when all observations were included in the analysis and slightly stronger associations were observed for women with addresses geocoded at the home or street level. For most of the exposure measures, stronger associations were observed among those of lower sociodemographic status. Conclusion: Our findings that more greenness associated with reduced maternal cortisol levels measured in the hair during the first trimester, could have substantial implications for urban planners and public health professional. If our observations will be replicated, it may present a useful avenue for public-health intervention to promote health through the provision of greenness exposure during early pregnancy, specifically to disadvantage populations.

Original languageEnglish
Article number112378
JournalEnvironmental Research
StatePublished - Mar 2022


FundersFunder number
Ihel Foundation
Planet Application Program Interface
Planet Education and Research program of Planet
Israel Science Foundation184/19


    • Greenness
    • Hair cortisol
    • Hypothalamic-pituitary-adrenal axis (HPA)
    • Normalised difference vegetation index (NDVI)
    • Small area sociodemographic status (SES)


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