Apgar score and risk of autism

Abstract

Low Apgar score has been associated with higher risk for several neurological and psychiatric disorders, including cerebral palsy and intellectual disability. Studies of the association between Apgar score and autism spectrum disorder (ASD) have been inconsistent. We aimed to investigate (1) the association between low Apgar score at 5 min and risk for ASD, and (2) the modifying effects of gestational age and sex on this association in the largest multinational database of ASD. We included prospective data from 5.5 million individuals and over 33,000 cases of ASD from Norway, Sweden, Denmark and Western Australia who were born between 1984 and 2007. We calculated crude and adjusted risk ratios (RR) with 95% confidence intervals (95% CIs) for the associations between low Apgar score and ASD. All analyses for ASD were repeated for autistic disorder (AD). We used interaction terms and stratified analysis to investigate the effects of sex, gestational age, and birth weight on the association. In fully adjusted models, low Apgar scores (1–3) (RR, 1.42; 95% CI, 1.16–1.74), and intermediate Apgar scores (4–6) (RR, 1.50; 95% CI, 1.36–1.65) were associated with a higher RR of ASD than optimal Apgar score (7–10). The point estimates for low (RR, 1.88; 95% CI, 1.41–2.51) and intermediate Apgar score (RR, 1.54; 95% CI, 1.32–1.81) were larger for AD than for ASD. This study suggests that low Apgar score is associated with higher risk of ASD, and in particular AD. We did not observe any major modifying effects of gestational age and sex, although there seems to be substantial confounding by gestational age and birth weight on the observed association. Electronic supplementary material The online version of this article (10.1007/s10654-018-0445-1) contains supplementary material, which is available to authorized users.

Associations between metabolic acidosis at birth and reduced Apgar scores within the normal range (7‐10): A Swedish cohort study of term non‐malformed infants

“…9 Reduced Apgar scores of 7-9 at 10 minutes were generally associated with the highest risks. We and others have reported similar findings with respect to Apgar scores within the normal range and risks of long-term outcomes, including CP and epilepsy, 2 autism, 10 developmental physical or emotional vulnerability in childhood, 11 and increasing needs of education in special schools. 12 Arterial umbilical cord blood analysis immediately after birth aims to assess intrapartal fetal stress, and metabolic acidosis may indicate birth asphyxia.…”

“…The primary objective of this study was to investigate associations between metabolic acidosis and risks of Apgar scores of 7, 8, and 9 at 5 and 10 minutes. We also estimated the joint impact of metabolic acidosis and Apgar score values within the normal range (7)(8)(9)(10), with respect to risk of neonatal morbidity. We also linked the database to the Swedish Neonatal Quality Register,…”

Association between Apgar scores of 7 to 9 and neonatal mortality and morbidity: population based cohort study of term infants in Sweden

“…The strong relations between Apgar scores of 7, 8, and 9 and neonatal morbidity, and the associations between pregnancy complications and lower Apgar scores in the normal range observed in our study, provide insight into previous findings of increased risks of cerebral palsy, epilepsy, autism, and adverse developmental outcomes in children with Apgar scores of 7, 8, and even 9, compared with an Apgar score of 10. 2 3 30 …”

Untargeted metabolomic study of autism in newborn screening samples: a pilot study

“…Methacholine was found to be significantly more abundant in cases when compared to controls (average intensity in cases 4.41E+07 and controls 3.94E+07) both when using a t-test (p = 0.0021) and a Wilcoxon rank-sum test (p = 0.0031). The corresponding node (ID159) in the network 17 Among the 273 compounds reported in two recent reviews [6,87], 22 were cited at least three times, of which 18 could be linked to features in our study after manual verification ( Table 3, Additional file 11).…”

“…Among perinatal outcomes, preterm birth (<37 weeks) and low birthweight (small for gestational age) have been associated with an increased risk of ASD as well as high frequency ventilation and intracranial hemorrhage [15]. Low Apgar scores, a score used to summarizing vital signs and assess health in newborns [16], also have recently been associated with an increased risk of developing ASD [17].…”