Impact of maternal education level on risk of low Apgar score

Objective: To investigate the association between 5-min Apgar score and socio-economic characteristics of pregnant women, particularly education level. Study design: Population-based cross-sectional study. Methods: This study used hospital records of live term singleton births in Brazil from 2004 to 2009, obtained from the Ministry of Health National Information System. Crude and adjusted odds ratios (ORS) were used to estimate the risk of a low 5-min Apgar score (<= 6) associated with maternal education level, maternal age, marital status, primiparity, number of prenatal visits and mode of delivery (vaginal/caesarean section). Results: Nearly 12 million records were analysed. Births from mothers with 0, 1-3, 4-7 and 8-11 years of education resulted in crude ORs for low 5-min Apgar score of 3.1, 2.2, 1.8 and 1.3, respectively (reference: >= 12 years of education). The crude OR for mothers aged >= 41 years (reference 21-34 years) was 1.4, but no risk was detected for those with >= 12 years of education and those who gave birth by caesarean section (OR 1.0 [95% confidence interval 0.9-1.2]). Generally, the risk of a low 5-min Apgar score was found to increase as maternal age moved away from 21 to 34 years (OR 1.1-1.7), and for mothers with the same characteristics, the risk of a low 5-min Apgar score was found to decrease markedly as education level increased (adjusted OR decreased from 2.6 to 1.2). Conclusion: Maternal education level is clearly associated with the risk of a low 5-min Apgar score. (C) 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.