Apgar score and risk of autism

Amirhossein Modabbernia, Sven Sandin, Raz Gross, Helen Leonard, Mika Gissler, Erik T. Parner, Richard Francis, Kim Carter, Michaeline Bresnahan, Diana Schendel, Mady Hornig, Abraham Reichenberg

Research output: Contribution to journalArticle

2 Citations (Scopus)

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 5min 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.

Original languageEnglish
Pages (from-to)105-114
Number of pages10
JournalEuropean Journal of Epidemiology
Volume34
Issue number2
DOIs
Publication statusPublished - Feb 2019

Cite this

Modabbernia, A., Sandin, S., Gross, R., Leonard, H., Gissler, M., Parner, E. T., ... Reichenberg, A. (2019). Apgar score and risk of autism. European Journal of Epidemiology, 34(2), 105-114. https://doi.org/10.1007/s10654-018-0445-1
Modabbernia, Amirhossein ; Sandin, Sven ; Gross, Raz ; Leonard, Helen ; Gissler, Mika ; Parner, Erik T. ; Francis, Richard ; Carter, Kim ; Bresnahan, Michaeline ; Schendel, Diana ; Hornig, Mady ; Reichenberg, Abraham. / Apgar score and risk of autism. In: European Journal of Epidemiology. 2019 ; Vol. 34, No. 2. pp. 105-114.
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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 5min 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.",
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Modabbernia, A, Sandin, S, Gross, R, Leonard, H, Gissler, M, Parner, ET, Francis, R, Carter, K, Bresnahan, M, Schendel, D, Hornig, M & Reichenberg, A 2019, 'Apgar score and risk of autism' European Journal of Epidemiology, vol. 34, no. 2, pp. 105-114. https://doi.org/10.1007/s10654-018-0445-1

Apgar score and risk of autism. / Modabbernia, Amirhossein; Sandin, Sven; Gross, Raz; Leonard, Helen; Gissler, Mika; Parner, Erik T.; Francis, Richard; Carter, Kim; Bresnahan, Michaeline; Schendel, Diana; Hornig, Mady; Reichenberg, Abraham.

In: European Journal of Epidemiology, Vol. 34, No. 2, 02.2019, p. 105-114.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Apgar score and risk of autism

AU - Modabbernia, Amirhossein

AU - Sandin, Sven

AU - Gross, Raz

AU - Leonard, Helen

AU - Gissler, Mika

AU - Parner, Erik T.

AU - Francis, Richard

AU - Carter, Kim

AU - Bresnahan, Michaeline

AU - Schendel, Diana

AU - Hornig, Mady

AU - Reichenberg, Abraham

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N2 - 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 5min 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.

AB - 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 5min 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.

KW - Epidemiology

KW - Autism

KW - Apgar score

KW - Etiology

KW - SPECTRUM DISORDERS

KW - CEREBRAL-PALSY

KW - INTELLECTUAL DISABILITY

KW - PSYCHIATRIC-DISORDERS

KW - PERINATAL FACTORS

KW - SUBSEQUENT DEATH

KW - ASSOCIATION

KW - OUTCOMES

KW - COMPLICATIONS

KW - DEPRESSION

U2 - 10.1007/s10654-018-0445-1

DO - 10.1007/s10654-018-0445-1

M3 - Article

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JO - European Journal of Epidemiology

JF - European Journal of Epidemiology

SN - 0393-2990

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Modabbernia A, Sandin S, Gross R, Leonard H, Gissler M, Parner ET et al. Apgar score and risk of autism. European Journal of Epidemiology. 2019 Feb;34(2):105-114. https://doi.org/10.1007/s10654-018-0445-1