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    Can Apgar scores also predict maternal health?


    Five-minute Apgar scores have long been a yardstick for assessing infant wellbeing at birth. The scores also may serve as an indicator of poor maternal health, say Canadian researchers in a research letter published in JAMA Pediatrics.

    The authors based their conclusions on a study of 612,980 live singleton births in Ontario, Canada from April 2006 to March 2012. Their goal was to determine whether a low, intermediate, or normal newborn Apgar score at 5 minutes was associated with maternal postpartum intensive care unit (ICU) admission.

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    The researchers stratified the births by preterm (24 to 36 weeks) versus term (≥37 weeks); hypertensive disorders in pregnancy; as well as the median interval between delivery and admission to the ICU. They used modified Poisson regression analysis to generate unadjusted and adjusted relative risks. Adjustments were made for maternal age, parity, income quintile, pre-pregnancy diabetes mellitus, obesity, drug dependence or tobacco use, and newborn sex.

    The rate of maternal ICU admission was 1.7 per 1000 among mothers of neonates with normal 5-minute Apgar scores (7-10). As the scores fell, however, the rates of maternal ICU admission rose, to 13.0 per 1000 with an intermediate score (4 to 6) and 18.8 per 1000 for lower scores. The ICU admission rates were high among women who delivered preterm or had a hypertensive disorder, but the adjusted relative risk was more pronounced in term births or in the absence of hypertensive disorders. In addition, the adjusted relative risks were higher among women who were admitted to the ICU within 4 hours of delivery.

    “A low 5-minute Apgar score,” the authors said, “reflects a higher risk of maternal ICU admission with and without mechanical ventilation.” They recommend, as a next step, assessing whether use of Apgar scores can improve the performance of models that are used to predict severe, acute maternal morbidity.

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    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.
    Miranda Hester
    Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.


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