TY - JOUR
T1 - Association of Apgar score at 5 minutes with academic performance and intelligence in youth
T2 - A cohort study
AU - Ladelund, Agnes Kielgast
AU - Bruun, Frederik Jager
AU - Slavensky, Julie Anna
AU - Ladelund, Steen
AU - Kesmodel, Ulrik Schiøler
N1 - © 2022 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).
PY - 2022/3
Y1 - 2022/3
N2 - 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.
AB - 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.
KW - Apgar score
KW - academic performance
KW - cognitive function
KW - intelligence
KW - school performance
UR - http://www.scopus.com/inward/record.url?scp=85123471629&partnerID=8YFLogxK
U2 - 10.1111/aogs.14320
DO - 10.1111/aogs.14320
M3 - Journal article
C2 - 35075636
SN - 0001-6349
VL - 101
SP - 303
EP - 312
JO - Acta Obstetricia et Gynecologica Scandinavica
JF - Acta Obstetricia et Gynecologica Scandinavica
IS - 3
ER -