Proportion and factors associated with Apgar less than 7 in the 5th minute of life: from 1999 to 2019, what has changed?

Magalhães, Alessandra Lourenço Caputo; Monteiro, Denise Leite Maia; Trajano, Alexandre José Baptista; Souza, Flavio Monteiro de

doi:10.1590/1413-81232023282.11162022EN

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ARTICLE • Ciênc. saúde coletiva 28 (2) • Feb 2023 • https://doi.org/10.1590/1413-81232023282.11162022EN copy

Proportion and factors associated with Apgar less than 7 in the 5th minute of life: from 1999 to 2019, what has changed?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Although variation between observers in the assessment of the Apgar score, it remains a useful indicator of the general conditions of the newborn. This is a cross-sectional study based on population of live births in Brazil in 1999 and biennium 2018-2019. All declarations of live births (DNV) obtained from the Live Births System database were accessed. Frequencies were compared between groups using Pearson’s chi-square test and multivariate logistic regression analysis was performed. A statistical significance level of 0.05 was considered. We included 9.050.521 DNVs in our research. We found that 2,1% of newborns had 5th minute Apgar < 7 in 1999 compared with 0,9% in 2018-2019. Multivariate analysis shows that twins and teenage pregnancy are no longer risk factors. Among risk factors, we observed an increase in prematurity, low birth weight and congenital anomalies. An improvement in maternal markers was observed, especially increase in the number of prenatal consultations and schooling. Such findings demonstrate the importance access and adequate prenatal care and improved socioeconomic conditions as effective strategy to reduce neonatal morbidity and mortality.

Key words:
Asphyxia neonatorum; Apgar score; Delivery of health care

Variable	1999		2018 and 2019		OR^a	95%CI^b
Variable	Number	%	Number	%
5th minute Apgar score	2,808,341		5,680,092
< 7	58,961	2.1	52,731	0.9	0.44	(0.43 - 0.44)
≥ 7	2,749,380	97.9	5,627,361	99.1	1.00	^c
Gestational age	2,765,872		5,607,382
22 to 27 weeks	10,036	0.4	25,363	0.5	1.24	(1.21 - 1.27)
28 to 36 weeks	155,811	5.6	593,840	10.6	1.87	(1.86 - 1.88)
37 to 41 weeks	2,381,313	86.1	4,850,615	86.5	1.00	^c
≥ 42 weeks	218,712	7.9	137,564	2.5	0.31	(0.31 - 0.32)
Birth weight	2,808,341		5,680,092
500 to 999g	7,747	0.3	26,841	0.5	1.72	(1.67 - 1.76)
1,000 to 1,499g	16,771	0.6	43,002	0.8	1.27	(1.25 - 1.29)
1,500 to 1,999g	38,991	1.4	92,292	1.6	1.17	(1.16 - 1.19)
2,000 to 2,499g	150,412	5.4	315,773	5.6	1.04	(1.03 - 1.05)
2,500 to 3,999g	2,433,043	86.6	4,907,907	86.4	1.00	^c
≥ 4,000g	161,377	5.7	292,277	5.2	0.90	(0.89 - 0.90)
Color	2,188,785		5,522,398
Black	883,127	40.3	3,496,313	61.6	1.00	^c
White	1,198,875	54.7	1,961,547	35.5	0.41	(0.41 - 0.41)
Others	106,783	4.9	64,538	1.1	0.15	(0.15 - 0.15)
Sex	2,803,208		5,680,092
Male	1,439,573	51.4	2,908,307	51.2	1.00	(1.00 - 1.00)
Female	1,363,635	48.6	2,770,934	48.8	1.00	^c
Congenital anomalies	2,808,341		5,573,375
Yes	5,262	0.2	49,913	0.9	4.80	(4.68 - 4.95)
No	2,803,079	99.8	5,523,462	99.1	1.00	^c

Variable	1999		2018 and 2019		OR^a	95%CI^b
Variable	Number	%	Number	%
Maternal age	2,782,520		5,679,957
10 to 19	641,946	23.1	851,455	15.0	0.64	(0.64 - 0.65)
20 to 34	1,908,258	68.6	3,924,607	69.1	1.00	^c
35 and over	232,316	8.3	903,895	15.9	1.89	(1.88 - 1.90)
Number of years of study	1,877,107		5,613,351
None	91,897	4.9	18,247	0.3	0.25	(0.25 - 0.25)
1 to 7 years	1,153,125	61.4	912,979	16.3	1.00	^c
8 and over	632,085	33.7	4,682,125	83.4	9.36	(9.32 - 9.39)
Number of pre-natal visits	2,612,010		5,656,916
None	129,492	4.9	83,359	1.5	0.49	(0.49 - 0.50)
1 to 6	1,135,659	43.5	1,475,226	26.1	1.00	^c
7 or more	1,346,859	51.6	4,098,331	72.4	2.34	(2.33 - 2.35)
Marital status	1,084,932		5,629,274
Single	385,084	35.5	2,515,808	44.7	1.48	(1.47 - 1.49)
Has been married	13,101	1.2	85,083	1.5	1.47	(1.45 - 1.50)
Is currently married	686,747	63.3	3,028,383	53.8	1.00	^c
Number of live births had previously	2,517,402		5,529,090
None	855,411	34.0	2,322,981	42.0	1.89	(1.88 - 1.90)
1 to 2	1,286,332	51.1	2,666,554	48.2	1.44	(1.44 - 1.45)
More than 2	375,659	14.9	539,555	9.5	1.00	^c
Fetal losses and miscarriages	2,218,070		5,442,001
None	1,933,479	87.2	4,390,192	80.7	1.00	^c
1 ore more	284,591	12.8	1,051,809	19.3	1.63	(1.62 - 1.63)

Variable	1999		2018 and 2019		OR^a	95%CI^b
Variable	Number	%	Number	%
Single or twinning pregnancy	2,800,555		5,676,538
Single	2,750,156	98.2	5,553,541	97.8	1.00	^c
Twinning	50,399	1.8	122,997	2.2	1.21	(1.20 - 1.22)
Type of childbirth	2,797,402		5,676,828
Vaginal	1,699,757	60.8	2,456,343	43.3	1.00	^c
C-section	1,097,645	39.2	3,220,485	56.7	2.03	(2.02 - 2.04)
Location of birth	2,805,280		5,676,959
Hospital	2,758,705	98.3	5,630,335	99.1	1.00	^c
Others (health establishments of 99 and estab+others 14-15)	42,942	1.5	37,905	0.7	0.43	(0.43 - 0.44)
Home	3,633	0.1	11,719	0.2	1.58	(1.52 - 1.64)
Region	2,808,341		5,680,092
North	254,084	9.0	607,529	10.7	1.32	(1.32 - 1.33)
Northeast	656,577	23.4	1,592,710	28.0	1.34	(1.34 - 1.35)
Southeast	1,231,248	43.8	2,222,610	39.1	1.00	^c
South	456,026	16.2	776,191	13.7	0.94	(0.94 - 0.95)
MIdwest	210,406	7.5	481,052	8.5	1.26	(1.26 - 1.27)

Variables		1999		2018 - 2019
Variables		OR^a	95% CI^b	OR^a	95% CI^b
Gestational age	22 to 27 weeks	5.10	(4.59 - 5.67)	6.64	(6.20 - 7.10)
	28 to 36 weeks	1.98	(1.89 - 2.08)	4.37	(4.31 - 4.43)
	37 to 41 weeks	1.00	^c	1.00	^c
	≥ 42 weeks	1.22	(1.15 - 1.30)	1.40	(1.30 - 1.49)
Birth weight	500-999 g	33.23	(29.93 - 36.90)	15.67	(14.68 - 16.74)
	1,000-1,499 g	13.23	(12.29 - 14.24)	6.96	(6.58 - 7.37)
	1,500-1,999 g	5.64	(5.29 - 6.02)	4.12	(3.93 - 4.31)
	2,000-2,499 g	2.17	(2.06 - 2.28)	1.99	(1.92 - 2.07)
	2,500-3,999 g	1.00	^c	1.00	^c
	≥ 4000 g	1.24	(1.16 - 1.32)	1.35	(1.29 - 1.42)
Color	Black	1.00	^c	1.00	^c
	White	0.57	(0.56 - 0.58)	0.81	(0.79 - 0.83)
	Others	1.07	(1.03 - 1.12)	1.38	(1.27 - 1.49)
Sex	Female	1.00	^c	1.00	^c
	Male	1.24	(1.21 - 1.28)	1.26	(1.23 - 1.28)
Congenital anomalies	Absent	1.00	^c	1.00	^c
	Presentes	5,44	(4,88 - 6,06)	8,30	(7,99 - 8,63)
Maternal age	10 to 19 years	1.05	(1.01 - 1.08)	1.00	^d (0.97 - 1.03)
	20 to 34 years	1.00	^c	1.00	^c
	35 years or over	1.12	(1.06 - 1.18)	1.05	(1.02 - 1.08)
Number of years of study	None	1.54	(1.44 - 1.64)	1.56	(1.39 - 1.83)
	1 to 7 years	1.25	(1.21 - 1.29)	1.19	(1.16 - 1.23)
	≥ 8 years	1.00	^c	1.00	^c
Number of pre-natal visits	None	1.37	(1.29 - 1.45)	1.77	(1.66 - 1.88)
	1 to 6	1.32	(1.28 - 1.37)	1.09	(1.06 - 1.11)
	≥ 7	1.00	^c	1.00	^c
Number of live children	None	1.00	^c	1.00	^c
	1 to 2	0.83	(0.80 - 0.85)	0.88	(0.83 - 0.87)
	More than 2	0.84	(0.80 - 0.85)	0.87	(0.84 - 0.90)
Deceased children	None	1.00	^c	1.00	^c
	One or more	1.13	(1.09 - 1.18)	1.04	(1.02 - 1.07)
Pregnancy	Single	1.00	^c	1.00	^c
	Twinning	0.95	(0.88 - 1.02)^d	0.70	(0.67 - 0.74)
Type of birth	Vaginal	0.92	(0.90 - 0.95)	1.42	(1.39 - 1.46)
	C-section	1.00	^c	1.00	^c
Location of birth	Hospital	1.00	^c	1.00	^c
	Non-hospital Health Estab.	1.34	(1.03 - 1.75)	1.41	(1.24 - 1.61)
	Home	1.71	(1.54 - 1.89)	1.36	(1.13 - 1.65)
Region	North	1.47	(1.39 - 1.56)	1.03	(0.99 - 1.07)^d
	Northeast	1.67	(1.61 - 1.73)	1.23	(1.20 - 1.26)
	Southeast	1.00	^c	1.00	^c
	South	0.90	(0.86 - 0.94)	1.21	(1.17 - 1.25)
	Midwest	1.00	(0.92 - 1.08)^d	1.00	(0.96 - 1.04)^d

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[1] Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva