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The Role of Neighborhood Greenspace in reducing Risk of Hypertensive Disorders of Pregnancy, Chronic Hypertension, and Racial Disparities in Maternal Morbidity

Award Number: R01HL157160
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 01/15/2022
PERIOD OF PERFORMANCE END DATE: 12/31/2026

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The Role of Neighborhood Greenspace in reducing Risk of Hypertensive Disorders of Pregnancy, Chronic Hypertension, and Racial Disparities in Maternal Morbidity - PROJECT SUMMARY Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal mortality and morbidity in the US, particularly for Black women who are at greatest risk of poor outcomes. In addition to contributions to maternal mortality, HDP increase the risk of chronic hypertension (cHTN), which can lead to cardiovascular (CV) disease. Neighborhood greenspace has been associated with improved CV outcomes in the general population, but few studies have evaluated the relationship between greenspace and the development of HDP and subsequent cHTN. The broad objective of this proposal is to fill this gap by evaluating the impact of greenspace and a greening intervention on HDP and cHTN as well as to determine the utility of greenspace as a racial disparities mitigation tool. We will merge GeoBirth, a cohort that will include 92,000 pregnant patients in Philadelphia, PA from 2008 to 2021, with several neighborhood greenspace datasets, including data from a randomized controlled trial of a greening intervention recently conducted by our team. Our overarching hypothesis is that living near greenspace lowers risk of HDP and cHTN and reduces Black- white racial disparities for these outcomes. We propose the following aims: 1) Observational: To determine if neighborhood greenspace is associated with HDP and cHTN after pregnancy and the extent to which greenspace mediates racial disparities in these outcomes. We will analyze associations of residential greenspace with risk of HDP using multilevel logistic regression adjusted for individual and neighborhood-level confounders (1a). We will determine if greenspace exposure is associated with risk of cHTN within 5 years after pregnancy using survival analysis methods (1b). We will quantify the extent to which higher greenspace exposure among Black women could reduce Black-white HDP and cHTN disparities using causal mediation and interaction analyses (1c). 2) Quasi-experimental: To measure the impact of a neighborhood greening intervention on HDP and cHTN after pregnancy, using a quasi-experimental design. We will analyze the impact of vacant lot greening on risks of HDP and cHTN in the 5 years after pregnancy, using a difference-in- differences analysis of women living near lots that were greened compared to control lots between 2008-2017. 3) Experimental: To examine the impact of a greening intervention on changes in blood pressure during pregnancy, using a previously conducted RCT. We will use data from a completed cluster RCT (2011-2014) vacant lot greening to examine the impact of greening on blood pressure changes (trajectories are associated with development of HDP) from 20 weeks' gestation to delivery, among GeoBirth participants living near 541 vacant lots in three trial conditions: greened lots, trash clean-up only lots, and control lots. The proposed study will be the largest investigation into whether neighborhood greenspace can mitigate HDP risk and cHTN risk after pregnancy and reduce racial disparities in these morbidities.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $709,441 )
2025	2025	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	000	4	11/26/2024	NON-COMPETING CONTINUATION	$638,497
2025	2025	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	001	4	8/12/2025	NON-COMPETING CONTINUATION	$70,944
														Subtotal = $709,441

Issue Date FY: 2024 ( Subtotal = $710,556 )
2024	2024	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	001	3	1/2/2024	NON-COMPETING CONTINUATION	$652,552
2024	2024	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	002	3	6/26/2024	NON-COMPETING CONTINUATION	$58,004
2024	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	003	2	6/27/2024	SUPPLEMENT FOR EXPANSION	$0
2024	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	000	2	10/11/2023	SUPPLEMENT FOR EXPANSION	$0
														Subtotal = $710,556

Issue Date FY: 2023 ( Subtotal = $1,235,973 )
2023	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	000	2	12/8/2022	NON-COMPETING CONTINUATION	$662,727
2023	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	002	2	8/21/2023	SUPPLEMENT FOR EXPANSION	$499,609
2023	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	001	2	3/8/2023	NON-COMPETING CONTINUATION	$73,637
														Subtotal = $1,235,973

Issue Date FY: 2022 ( Subtotal = $778,937 )
2022	2022	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	000	1	1/3/2022	NEW	$778,937
														Subtotal = $778,937

Grand Total All Awards = $3,434,907

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The Role of Neighborhood Greenspace in reducing Risk of Hypertensive Disorders of Pregnancy, Chronic Hypertension, and Racial Disparities in Maternal Morbidity

Award Number: R01HL157160

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 01/15/2022

PERIOD OF PERFORMANCE END DATE: 12/31/2026

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