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This research investigates the effects of air pollution and green space exposure on the attainment of neurodevelopmental milestones in early childhood.

March 5, 2026Environmental Health0 citationsOpen Access

Attaining neurodevelopmental milestones and exposures to fine particulate matter and environmental green spaces

JMJackline Vicent MbishiMuhimbili University of Health and Allied Sciences EBE BijnensOpen University of the Netherlands KHKim HolvoetDepartment of Public Health

Key Points

This research investigates the effects of air pollution and green space exposure on the attainment of neurodevelopmental milestones in early childhood.
Longitudinal population study of Flemish children born in 2018
Data collected from well-baby clinics (n = 46,584)
Assessment of milestone delays using the Dutch version of the Denver Developmental Screener
Analysis of perinatal air pollution (PM2.5, PM10) and green space using multivariable logistic and linear regression
PM2.5 exposure associated with delay in 'Points at 6 body parts of a doll' (OR = 1.13)
PM10 linked to delays in 'Says sentences of 2 words' and 'Pulls up to standing position' (ORs of 1.07 and 1.11)
Low green space associated with reduced delays in 'Says 2 sound-words with comprehension' (OR = 0.89) and 'Pulls up to standing position' (OR = 0.87)
High green space negatively associated with delays in several milestones, indicating a protective effect

Abstract

Early-life environmental exposures may influence infant neurodevelopment. We examined associations between perinatal air pollution, green space exposure, and milestone attainment during the first two years. We conducted a longitudinal population study of Flemish children born in 2018, using well-baby clinic data (n = 46,584). Outcomes were delay of six milestones within predefined windows assessed using the Dutch version of the Denver Developmental Screener, and the exact age at two milestones. Municipality-level PM2.5, PM10, and green space were assigned. Associations per interquartile-range (IQR) increase were estimated using multivariable logistic and linear regression with multiple imputation. PM2.5 was positively associated with delaying the milestone ‘Points at 6 body parts of a doll’ (OR = 1.13, 95% CI:1.04;1.22). PM10 was positively associated with delaying the milestones ‘Says sentences of 2 words’ (OR = 1.07, 95%CI:1.00;1.13), ‘Points at 6 body parts of a doll’ (OR = 1.11, 95%CI:1.05;1.18), and ‘Pulls up to standing position’ (OR = 1.11, 95%CI:1.02;1.22). Low green was significantly associated with a reduced odds of delaying the milestones ‘Says 2 sound-words with comprehension’ (OR = 0.89, 95%CI:0.85;0.93) and ‘Pulls up to standing position’ (OR = 0.87, 95%CI:0.81;0.94), and negatively associated with walking age in months (B=-0.094, 95%CI:-0.129;-0.059). High green was negatively associated with delaying the milestones ‘Says sentences of 2 words’ (OR = 0.96, 95%CI:0.94;0.99) and ‘Points at 6 body parts of a doll’ (OR = 0.93, 95%CI:0.89;0.96). Total green was negatively associated with delaying the milestones ‘Says 2 sound-words with comprehension’ (OR = 0.94, 95%CI:0.88;0.99) and ‘Points at 6 body parts of a doll’ (OR = 0.95, 95%CI:0.91;0.99), and also with walking age (B=-0.054, 95%CI:-0.089;-0.019). PM exposure was linked to delays, while green space exposure showed a protective association. These findings support reducing PM10/PM2.5) and promoting green space exposures for child development.

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