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We did not have access to information about maternal mobility during gestation.
Furthermore, potential bias resulting from a lack information and possible maternal mobility during pregnancy could lead to differences in exposure not measured in this study.
However, these studies found little difference in mobility between cases and controls (Lupo et al. 2010a; Miller et al. 2010), and maternal mobility did not significantly influence the assessment of benzene exposure (Lupo et al. 2010a).
McKenzie et al. (2014) acknowledged in their article that there is a "lack of temporal and spatial specificity" in their exposure metric, but they appear to primarily relate this to uncertainties such as potential maternal mobility and relative well activity levels.
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Unfortunately, no estimates of maternal residential mobility during pregnancy exist for the state of Indiana.
Maternal residential mobility between conception and birth may lead to misclassification of exposure if the water source at birth is used in studies of spontaneous abortions and congenital malformations.
Our exposure assessment was based on each mother's residential address at the time of delivery, which may result in exposure misclassification due to maternal residential mobility during pregnancy.
Our measure of surrounding greenness was based on the mother's residential address at the time of delivery, which may not capture cumulative impacts of surrounding greenness over time (for instance, on physical activity behaviors) or changes in exposure due to maternal residential mobility during pregnancy.
This is important because studies investigating maternal residential mobility during pregnancy in relation to birth defects have reported varying rates (12 32%) of women changing address during pregnancy (Canfield et al. 2006; Fell et al. 2004; Khoury et al. 1988; Shaw and Malcoe 1992).
Prolonged maternal recovery, restricted mobility and other minor health problems after caesarean section have also been reported [ 54].
The impacts on mobility of maternal age and area-level socio-economic indicators were explored using standard descriptive statistics.
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