Prenatal exposure to residential greenness and artificial light at night and neurodevelopmental outcomes in children aged 4-12 years: A retrospective cohort study in China.

BACKGROUND: Neurodevelopmental outcomes may be shaped by modifiable residential environmental exposures during pregnancy; however, in rapidly urbanizing contexts, evidence on prenatal greenness and artificial light at night (ALAN) across multiple neurodevelopmental outcomes, including critical exposure windows and spatial characteristics, remains limited. METHODS: We analyzed 814 children aged 4-12 years from an ongoing cohort in southern China. Prenatal greenness was assessed across multiple spatial buffers, while ALAN was estimated at the address level. Multivariable regression models were used to examine associations with cognitive, motor, behavioral, learning, and ASD-related outcomes, stratified by urbanicity, with additional gestational-window analyses and interpretable machine-learning approaches. RESULTS: Among urban children, higher prenatal greenness was associated with better cognitive performance (FSIQ: β = 3.95, 95% CI: 0.75-7.16) and motor coordination (β = 3.60, 95% CI: 1.27-5.93), with weaker or null associations in non-urban areas and benefits plateauing beyond a 2-km buffer. Prenatal ALAN exposure was associated with poorer motor performance (β = -1.94, 95% CI: -3.33--0.55) and increased odds of ASD-related traits (OR = 3.69, 95% CI: 1.50-9.08) among urban children, and with hyperactivity in suburban children. Time-window analyses indicated outcome-specific patterns: greenness was associated with working memory in the first and second trimesters, and ALAN was most strongly associated with motor outcomes in the third trimester and with behavioral outcomes cumulatively. CONCLUSIONS: Prenatal greenness and ALAN were associated with child neurodevelopment, suggesting benefits of urban greening and potential harms of nighttime illumination, with associations more evident in urban and suburban settings across multiple neurodevelopmental outcomes.