Five-minute Apgar score and educational outcomes: retrospective cohort study of 751 369 children

Tweed, Emily J; Mackay, Daniel; Nelson, Scott M.; Cooper, Sally‐Ann; Pell, Jill P.

doi:10.1136/archdischild-2015-308483

Cited by 35 publications

(37 citation statements)

References 33 publications

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“…19 A low Apgar score 20 -a commonly used indicator of health in the immediate neonatal period -has been shown to be associated with increased neonatal and infant mortality 21 and additional educational support needs in later life. 22 Considerable attention has been focused on the causal determinants of low birthweight in order to identify potentially modifiable factors. A substantial proportion of low birthweight is attributable to the mother's cultural and socioeconomic circumstances, such as socioeconomic status (SES), harmful behaviours (smoking and excessive alcohol consumption) and poor nutrition during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Health in Pregnancy grants in Scotland: a natural experiment using routine data

et al. 2017

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Background Pregnancy and the period around birth are critical for the development and improvement of population health as well as the health of mothers and babies, with outcomes such as birthweight influencing adult health. Objectives We evaluated the clinical effectiveness and cost-effectiveness of the Health in Pregnancy (HiP) grants in Scotland, looking for differential outcomes when the scheme was in place, as well as before its implementation and after its withdrawal. Design The HiP grants were evaluated as a natural experiment using interrupted time series analysis. We had comparison groups of women who delivered before the grants were introduced and after the grants were withdrawn. Setting Scotland, UK. Participants A total of 525,400 singleton births delivered between 24 and 44 weeks in hospitals across Scotland between 1 January 2004 and 31 December 2014. Intervention The HiP grant was a universal, unconditional cash transfer of £190 for women in Great Britain and Northern Ireland reaching 25 weeks of pregnancy if they had sought health advice from a doctor or midwife. The grant was introduced for women with a due date on or after 6 April 2009 and subsequently withdrawn for women reaching the 25th week of pregnancy on or after 1 January 2011. The programme was paid for by Her Majesty’s Treasury. Main outcome measures Our primary outcome measure was birthweight. Secondary outcome measures included maternal behaviour, measures of size, measures of stage and birth outcomes. Data sources The data came from the Scottish maternity and neonatal database held by the Information and Services Division at the NHS National Services Scotland. Results There was no statistically significant effect on birthweight, with births during the intervention period being, on average, 2.3 g [95% confidence interval (CI) –1.9 to 6.6 g] lighter than would have been expected had the pre-intervention trend continued. Mean gestational age at booking (i.e. the first antenatal appointment with a health-care professional) decreased by 0.35 weeks (95% CI 0.29 to 0.41 weeks) and the odds of booking before 25 weeks increased by 10% [odds ratio (OR) 1.10, 95% CI 1.02 to 1.18] during the intervention but decreased again post intervention (OR 0.91, 95% CI 0.83 to 1.00). The odds of neonatal death increased by 84% (OR 1.84, 95% CI 1.22 to 2.78) and the odds of having an emergency caesarean section increased by 7% (OR 1.07, 95% CI 1.03 to 1.10) during the intervention period. Conclusions The decrease in the odds of booking before 25 weeks following withdrawal of the intervention makes it likely that the HiP grants influenced maternal health-care-seeking behaviour. It is unclear why neonatal mortality and emergency caesarean section rates increased, but plausible explanations include the effects of the swine flu outbreak in 2009 and the global financial crisis. The study is limited by its non-randomised design. Future research could assess an eligibility threshold for payment earlier than the 25th week of pregnancy. Funding The National Institute for Health Research Public Health Research programme. The Social and Public Health Sciences Unit is core funded by the Medical Research Council (MC_UU_12017/13) and the Scottish Government Chief Scientist Office (SPHSU13).

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Section: Introductionmentioning

confidence: 99%

Evaluation of Health in Pregnancy grants in Scotland: a natural experiment using routine data

et al. 2017

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“…Apgar scores (≤3) and special needs due to physical and motor impairment. 25 It has been suggested that birth around 40 weeks is associated with the lowest risk of developmental vulnerability 26 and special needs. 24 Overall, we found no difference in educational achievement of the children at ages 5 and 8, although children with special needs were exempt from testing.…”

Section: Discussionmentioning

confidence: 57%

“…25 It has been suggested that birth around 40 weeks is associated with the lowest risk of developmental vulnerability 26 and special needs. 25 It has been suggested that birth around 40 weeks is associated with the lowest risk of developmental vulnerability 26 and special needs.…”

Section: Discussionmentioning

confidence: 99%

Childhood health and education outcomes following early term induction for large‐for‐gestational age: A population‐based record linkage study

Ibiebele

Bowen

Nippita

et al. 2018

Acta Obstet Gynecol Scand

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Introduction:There is debate about optimal management of pregnancies with a large-for-gestational age baby. A recent randomized controlled trial reported that early term induction of labor reduced cesarean section rates and infant morbidity. However, long term childhood outcomes have not been assessed. The aim of this study was to assess maternal, neonatal and child health and education outcomes for large-for-gestational age babies induced at 37-38 weeks' gestation. Material and methods:Population-based record linkage study of term (37+ weeks), cephalic-presenting singleton pregnancies with a large-for-gestational age baby in New South Wales, Australia, 2002Australia, -2006. Linked birth, hospital, mortality and education data were used with at least 9 years follow up from birth. Exposure was induction of labor at 37-38 weeks, compared to expectant management (spontaneous birth at ≥37 weeks and planned births at ≥39 weeks). Relative risks and 95% confidence intervals were estimated using Modified Poisson regression with robust variance.Results: Among 10 174 eligible pregnancies, 412 (4.0%) had an induction at 37-38 weeks. Women in the induction group were less likely to have a cesarean section (RR: 0.65, 95% CI: 0.51-0.82). Infants had higher rates of: low Apgar scores, birth trauma, neonatal jaundice and phototherapy use, and admission to special care nursery or neonatal intensive care than their expectantly managed counterparts. As children, they had higher rates of hospital admission (RR: 1.16, 95% CI: 1.04-1.30) and special needs (RR: 1.98, 95% CI: 1.12-3.50). However, by age 8 there was no difference in overall literacy and numeracy achievement. Conclusions:Although women who had an early term labor induction with large-forgestational age were less likely to have a cesarean section, the increased risk of neonatal morbidities and additional healthcare utilization suggests the need for caution in early induction of large-for-gestational age babies before 39 weeks' gestation. K E Y W O R D Sbirth injuries, dystocia, fetal macrosomia, gestational age, hospitalization, induction of labor, large-for-gestational age, literacy

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“…For more than 60 years, it has been used to measure the condition of newborn infants based on heart rate, respiration, colour, muscle tone and reflex irritability (1). Subsequent studies have demonstrated the Apgar score's ability to predict short-term and long-term cognitive outcomes (2,3) as well as developmental impairment (4,5). As an index of early neonatal conditions and health, the Apgar score could, in theory, also be used as a measure of stressful exposures during delivery and early life.…”

Section: Introductionmentioning

confidence: 99%

Shared unmeasured characteristics among siblings confound the association of Apgar score with stress resilience in adolescence

et al. 2019

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AimWe investigated the association between low Apgar score, other perinatal characteristics and low stress resilience in adolescence. A within‐siblings analysis was used to tackle unmeasured shared familial confounding.MethodsWe used a national cohort of 527 763 males born in Sweden between 1973 and 1992 who undertook military conscription assessments at mean age of 18 years (17–20). Conscription examinations included a measure of stress resilience. Information on Apgar score and other perinatal characteristics was obtained through linkage with the Medical Birth Register. Analyses were conducted using ordinary least squares and fixed‐effects linear regression models adjusted for potential confounding factors.ResultsInfants with a prolonged low Apgar score at five minutes had an increased risk of low stress resilience in adolescence compared with those with highest scores at one minute, with an adjusted coefficient and 95% confidence interval of −0.26 (−0.39, −0.13). The associations were no longer statistically significant when using within‐siblings models. However, the associations with stress resilience and birthweight remained statistically significant in all analyses.ConclusionThe association with low Apgar score seems to be explained by confounding due to shared childhood circumstances among siblings from the same family, while low birthweight is independently associated with low stress resilience.

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Five-minute Apgar score and educational outcomes: retrospective cohort study of 751 369 children

Abstract: Background

Cited by 35 publications

References 33 publications

Evaluation of Health in Pregnancy grants in Scotland: a natural experiment using routine data

Evaluation of Health in Pregnancy grants in Scotland: a natural experiment using routine data

Childhood health and education outcomes following early term induction for large‐for‐gestational age: A population‐based record linkage study

Shared unmeasured characteristics among siblings confound the association of Apgar score with stress resilience in adolescence

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