(236) Apgar-5 scores variability and associated pregnancy outcomes among hospitalized women: Insights from national linked Brazilian secondary databases

Background: Apgar-5 scores is a 5 minutes-post-birth standardized assessment tool for infant’s physical condition comprising color, heart rate, reflexes, muscle tone, and respiration, ranging from 0 to 10, with 7 or more considered as normal. Understanding disparities in infants’ Apgar scores is crucial for identifying potential areas of intervention towards improving perinatal care.

Objectives: To identify a pregnancy cohort and pregnancy outcome, link mother-baby data and describe infants’ Apgar scores in national secondary (administrative) health databases in Brazil.

Methods: This is an observational retrospective claims database study. The study period included data from January 2021 to December 2022. Corresponding infant data from the SINASC (Live Birth Information System) database was probabilistically linked to mother’s data in SIH (Hospitalization Information System) using the mother's date of birth, month of the hospitalization, month of birth, and hospital identification code. Infants’ Apgar-5 scores and maternal characteristics were extracted. Diagnosis and procedures code lists were applied to identify the hospitalized pregnancy cohort, and birth outcomes such as high-risk deliveries, extreme low birth weights, and preterm births.

Results: The study included 1,809,864 hospitalized women in labor. Out of the hospitalizations/births, 16,038 (0.87%) had Apgar-5 scores values below 7 (i.e., abnormal score requiring medical attention) at the 5th minute after delivery, among which 5,043 had a score below 3, and 10,995 between 4 and 6. Abnormal Apgar-5 scores were most prevalent in the Southwest (approximately 40%) and least prevalent in the Midwest (approximately 7%). Maternal education showed minimal influence on Apgar-5 scores as approximately 60% of mothers had up to a high school education. High-risk deliveries, extreme low birth weights, and preterm births were most common with lower Apgar-5 scores (respectively; 23.4%, 32.1%, and 51.2% in those with a score less than 3, vs. 12.5%, 0.3%, and 9.1% in those with a score of more than 7). C-section rates for non-high-risk deliveries increased by the increase of Apgar-5 score for up to 35.9% in patients with a score of more than 7.

Conclusions: Apgar-5 scores variability is associated with birthweight and gestational age. Utilizing linked secondary health databases with national coverage may facilitate the development of predictive models for targeted interventions to improve perinatal care.