Investigation of the maternal and neonatal factors affecting the Apgar score of newborns: a case-control study


1 Department of Social Medicine, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran.

2 Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran.

3 Department of Clinical Biochemistry, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

4 Department of Midwifery, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran.

5 Department of Pediatrics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.

6 Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran AND Student Research Committee, School of Health, Ilam University of Medical Sciences, Ilam, Iran.


Background: Apgar score is a method for clinical evaluation of neonate at birth, and predicts their clinical conditions and physical or mental development. This score is affected by different factors during pregnancy and birth. This study aimed to investigate the relationship between some neonatal and maternal factors during pregnancy on the Apgar score.
Methods: This case-control study was conducted on 234 neonates born in Ilam hospitals during 2015-2016. The case group included 81 neonates with Apgar score <7 and control group containing 153 neonates with Apgar score ≥7in minute1 as well as 48 cases and 96 controls in minute 5. Data analysis was performed using descriptive statistics, Chi-square test, Fisher's exact test and odds ratio.
Results: The mean maternal weights in the case and control groups were 66.8 ± 13.5 and 67.1 ± 11.1 Kg, respectively. The mean± SD for maternal age 29 ± 5 vs. 29 ± 5.7 years, marriage age 22 ± 3 vs. 22.2 ± 4.9 years, BMI 24.5±3.2 vs. 26.1 ± 4.1 and weight gain during pregnancy 13.8 ± 6.2 vs. 12.7 ± 6.8 kg among cases and controls, respectively. The odds ratio for the following factors was significantly higher among cases than the control group: preterm delivery (OR:3.3 CI95%: 1.2-17), twin birth (OR:8.9 CI95%: 2.6-27.2), abnormal presentation of the fetus (OR:6 CI95%: 2.3-15.6), birth weight (OR:6.9 CI95%: 1.4-28.6) and placental abruption (OR:9.4 CI95%: 2.2-22.5)for Apgar score at five minute.  
Conclusion: Based on the findings of the present study, preterm labor, multiple birth, abnormal fetal presentation, low birth weight, premature rupture of membrane, placental abruption and anemia, led to an increase in Apgar score less than 7.