Related Experiment Video
Updated: Oct 5, 2025
Quantified Assessment of Infant's Gross Motor Abilities Using a Multisensor Wearable
Published on: May 17, 2024
Association of Apgar score at 5 minutes with academic performance and intelligence in youth: A cohort study
Agnes Kielgast Ladelund1, Frederik Jager Bruun1, Julie Anna Slavensky1
1Department of Obstetrics and Gynecology, Herlev and Gentofte Hospital, Herlev, Denmark.
Insights
Children with low Apgar scores at birth (below 7) had lower chances of graduating upper secondary education and attending conscription. However, if they participated, their academic performance and intelligence were comparable to peers with higher Apgar scores.
Area of Science:
- Pediatrics
- Developmental Neuroscience
- Educational Psychology
Background:
- The Apgar score is a standard childbirth assessment, with low scores at 5 minutes indicating increased risk for neonatal death and potential later neurologic disability.
- Existing research on the association between Apgar scores and long-term cognitive function is contradictory, necessitating further investigation.
Purpose of the Study:
- To investigate the association between Apgar scores at 5 minutes and academic performance and intelligence in youth.
- To clarify the relationship between early-life Apgar scores and later educational and cognitive outcomes.
Main Methods:
- A Danish cohort study included over 1 million liveborn children from 1978-2000, utilizing national registers for comprehensive data.
- Data on birth, schooling, and intelligence were analyzed using logistic and linear regressions after multiple imputations to handle missing data.
Main Results:
- No significant association was found between Apgar score and primary school graduation.
- Children with Apgar scores below 7 showed significantly lower odds of graduating upper secondary education and attending conscription.
- The Apgar 4-6 group exhibited lower mean primary school grades and intelligence scores at conscription.
Conclusions:
- While Apgar scores below 7 were linked to reduced participation in upper secondary education and conscription, those who participated performed comparably to peers.
- Overall academic performance and school attendance were largely similar across Apgar score groups, with notable exceptions in higher education and conscription participation.
Introduction:
The Apgar score is routinely given at childbirth worldwide. A low Apgar score at 5 minutes is a strong predictor for neonatal death. Scores below 7 have been associated with higher risks of later neurologic disability. Few studies have assessed the association between Apgar score and school performance and intelligence. The existing literature points towards a possible association between Apgar score and later cognitive function, but the contradictions call for further investigation to fully understand the potential association. This study aimed to examine the possible association between Apgar score at 5 minutes and academic performance and intelligence in youth.
Material And Methods:
The study is a cohort study. The cohort consists of all Danish liveborn children in 1978-2000 (n = 1 450 681). Data regarding pregnancies, births, parents, school grades, and intelligence of the children were retrieved from different Danish registers. Multiple imputations were performed to avoid discarding data. After exclusion, the final cohort consisted of 1 005 241 children. Associations between Apgar score at 5 minutes and school graduation, grades and attendance, and intelligence scores from conscription were analyzed using univariate and multivariate logistic and linear regressions.
Results:
No association was found between Apgar score and graduating primary school. Adjusted odds ratio (aOR) of graduating upper secondary education and attending conscription were significantly lower for children with scores below 7 compared with 7-10: graduating upper secondary education: Apgar 0-3: aOR 0.79 (95% CI 0.67-0.93), Apgar 4-6: aOR 0.86 (95% CI 0.81-0.93), attending conscription: Apgar 0-3: aOR 0.73 (95% CI 0.59-0.91), Apgar 4-6: aOR 0.73 (95% CI 0.66-0.80). The Apgar 4-6 group had significantly lower total mean primary school grade average: -0.13 (95% CI -0.21 to -0.054) and lower mean intelligence scores at conscription: -0.57 (95% CI -1.09 to -0.058). All other differences remained insignificant.
Conclusions:
Performances when graduating school and attending conscription were overall equal regardless of Apgar score at 5 minutes. Chances of graduating primary school were the same irrespective of the score, but chances of graduating upper secondary education and attending conscription were significantly lower with scores below 7. The results suggest that children with scores below 7 may fail to appear at upper secondary education and conscription, but if they do, they perform equally to anyone else.
Related Concept Videos
01:29Environmental Influences on Intelligence
01:30Biological Influences on Intelligence
01:29Measures of Intelligence
Validity refers to how well a test measures what it claims to measure. An intelligence test should accurately assess intelligence rather than another characteristic, like anxiety. Criterion validity is one way to evaluate this;...
01:23Binet's Contribution to Measures of Intelligence
01:23Wechsler's Contribution to Measures of Intelligence
02:20Correlations