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A cohort study of low Apgar scores and cognitive outcomes
D E Odd1, F Rasmussen, D Gunnell
1Clinical Science at North Bristol, Paul O'Gorman Lifeline Centre, Southmead Hospital, Bristol BS10 5NB, UK. mddeo@bristol.ac.uk
Insights
Infants with low Apgar scores at birth had a higher risk of lower intelligence quotients (IQs) later in life. However, these birth conditions did not affect educational achievement and had a small overall impact.
Area of Science:
- Perinatal health
- Developmental psychology
- Public health
Background:
- Low Apgar scores indicate infant distress at birth.
- The long-term effects of transiently low Apgar scores on cognitive development are not fully understood.
Purpose of the Study:
- To examine the association between low Apgar scores (brief and prolonged) and later educational achievement and intelligence quotients (IQs).
- To investigate the impact of birth condition on long-term cognitive and academic outcomes.
Main Methods:
- A population-based cohort study of 176,524 male infants born in Sweden (1973-1976).
- Record linkage of birth data with conscription medical records (IQ) and school registers.
- Exclusion of premature infants and those with encephalopathy.
Main Results:
- Infants with brief or prolonged low Apgar scores showed an increased likelihood of low IQ scores.
- A longer duration to achieve a normal Apgar score correlated with a higher risk of low IQ.
- No significant association was found between low Apgar scores and educational achievement at age 15-16.
Conclusions:
- Infants experiencing poor condition at birth face an elevated risk of cognitive impairment.
- Mild fetal compromise, indicated by transiently low Apgar scores, appears to have a limited clinical impact on overall functioning.
Objective:
To investigate the association of brief (0-5 minutes) and prolonged (>5 minutes) low Apgar scores (<7) in non-encephalopathic infants with educational achievement at age 15-16 and intelligence quotients (IQs) at age 18.
Design:
Population-based record-linkage cohort study of 176 524 male infants born throughout Sweden between 1973 and 1976.
Patients And Methods:
Data from the Medical Birth Register were linked to Population and Housing Censuses, conscription medical records (IQ), and school registers (summary school grade). Infants were classified according to the time for their Apgar score to reach 7 or above. Premature infants and those with encephalopathy were excluded.
Results:
Infants with brief (OR = 1.14 (1.03-1.27)) or prolonged (OR = 1.35 (1.07-1.69)) low Apgar scores were more likely to have a low IQ score. There was an increased risk of a low IQ score (p = 0.003) the longer it took the infant to achieve a normal Apgar score. There was no association between brief (OR = 0.96 (0.87-1.06)) or prolonged (OR = 1.01 (0.81-1.26)) low Apgar scores and a low summary school grade at age 15-16, or evidence for a trend in the risk of a low school grade (p = 0.61). The estimated proportion with an IQ score below 81 due to transiently low Apgar scores was only 0.7%.
Conclusions:
Infants in poor condition at birth have increased risk of poor functioning in cognitive tests in later life. This supports the idea of a "continuum of reproductive casualty", although the small individual effect suggests that these mild degrees of fetal compromise are not of clinical importance.
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