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Background/aim Evidence of the impact of green spaces on pregnancy outcomes is still limited. We analysed green spaces and socio-economic position (SEP) as effect modifiers of the effect of high temperatures and air pollutants (PM10, NO2 and O3) on the risk of preterm birth (PB). Methods A cohort of new-borns in Rome, from April to October, 2001–2013, were analysed. Pre-terms, identified through the Certificate of Delivery Care Registry, were defined as births between the 22nd and the 36th week of gestation. A time series approach was used, with maximum apparent temperature (MAT), PM10, NO2 and O3 as exposure variables. We used a lag of 0–2 days for all exposure when analysing preterm births, except for PM10 (lag of 12–22 days). As green indicators we considered both the distance between mothers’ residence address and green spaces and the Normalised Difference Vegetation Index (NDVI) within a 100 m buffer centred on woman’s residence address. Women were also classified according to age, SEP and education level. Results We enrolled 56 576 total births, 5.1% of which PB. In our cohort 24% of women were younger than 30 years, 36% had a low SEP and 33% completed primary school. We observed a 2.0% (95% CI: 0.7 to 3.2) increase in the daily number of PB per 1°C increase in MAT, adjusting by PM10. Among pollutants only PM10 was associated to a significant increase in PB (+0.7%; 95% CI: 0.1 to 1.3) per 1 mg/m3 increase in PM10 (adjusted by MAT). SEP was an effect modifier for both MAT/PB and PM10/PB relationship; MAT increased the risk of PB only among women of medium or low SEP while PM10 among those of high SEP. Green was an effect modifier of MAT/PB relationship, with the highest effect of MAT on PB among women living very close to green spaces (within 100 m). Conclusion Socio-economic position resulted to be an important effect modifier for both MAT/PB and PM10/PB relationship. In particular we found the highest effect of temperature on preterm birth risk in women with low socio-economic position and living very close to green areas. How green acts in modifying this association should be further investigated.

Introduction We have carried out a systematic review of epidemiological studies about the association between extreme weather conditions and work-related injuries (WRI). Furthermore, we have analysed the association between extreme temperature, air pollutants and WRI in three Italian cities identifying more susceptible workers’ categories by the means of a case cross over study. Methods We have performed a systematic review of epidemiological studies concerning the risk of WRI for extreme temperature. All occupational injuries between 2001–2010 in Milan, Turin and Rome have been extracted from the Italian workers compensation claims archives. Associations between temperature (T), air pollutants (PM10, NO2, O3) and WRI have been estimated using a time-stratified case-crossover study, separately in May-September (warm season, WS) and November-February (cold season, CS). Results The epidemiological studies for estimating the association between extreme temperature and WRI appeared to be few and conducted with different methodologies. In our study exposure to NO2 (lag 0–8) showed the highest positive effect on the risk of WRI ranging, in the warm season, between +20% (CI 95%: 1.16–1.24) in Milan and +30% (CI 95%: 1.24–1.37) in Turin. Temperature, in WS, was associated to an increased risk of WRI among those working in construction, transport and energy industry with bricklayer, metalworker, mechanic, and asphalter as the most involved workers’ categories. Conclusions The findings of our study should be considered for planning health and safety prevention programs and correctly identifying measure targeted to risk mitigation for specific categories of workers.