Associations between Apgar scores and children’s educational outcomes at eight years of age

Engida Yisma*, Ben W. Mol, John W. Lynch, Murthy N. Mittinty, Lisa G. Smithers

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Background: Low Apgar scores are associated with neonatal morbidity and mortality, but effects of Apgar scores of 0–5, 6, 7, 8 and 9 (compared with 10) on longer-term neurodevelopmental outcomes are less clear. Aim: To examine the associations between Apgar scores of 0–5, 6, 7, 8 and 9 (compared with 10) and children’s educational outcomes as measured by the Australian National Assessment Program—Literacy and Numeracy (NAPLAN) tests at age eight. Materials and Methods: We merged perinatal data including all children born in South Australia from 1999 to 2008 with school assessment data (NAPLAN). School assessments included five learning areas (domains)—reading, writing, spelling, grammar and numeracy. Each domain was categorised according to performing at or below National Minimum Standards (≤NMS). Effects were estimated using Augmented Inverse Probability Weighting (AIPW) accounting for a range of maternal, perinatal and sociodemographic characteristics. Results: Risk differences comparing five-minute Apgar scores of 0–5 with Apgar scores of 10 for children performing ≤NMS for each domain were: reading (0.07 (95% CI −0.16 to 0.29)), writing (0.27 (95% CI −0.14 to 0.68)), spelling (0.15 (95% CI −0.10 to 0.40)), grammar (0.04 (95% CI −0.21 to 0.29)) and numeracy (0.21 (95% CI −0.04 to 0.45)). Risk differences for children performing ≤NMS were also evident when Apgar score of 6 was compared with Apgar score of 10. Conclusions: Children with five-minute Apgar scores of 0–5 and 6, compared with Apgar score of 10, are at higher risk of scoring at/below the NMS on the NAPLAN assessments at eight years.

Original languageEnglish
Pages (from-to)35-41
Number of pages7
JournalAustralian and New Zealand Journal of Obstetrics and Gynaecology
Issue number1
Early online date24 Aug 2020
Publication statusPublished - 1 Feb 2021

Bibliographical note

We thank the data custodians, the Australian Government Department of Education and Training, the South Australian Government Department for Health and Ageing and the Department for Education and Child Development for providing the de‐identified datasets for analysis. We thank SA‐NT DataLink for the data linkage. The views expressed in this paper do not necessarily reflect the views or policies of the data custodians. The first author (EY) is fully supported by an Australian Government Research Training Program Scholarship (RTPS). BWM is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant (GNT1176437) and also reports consultancy for ObsEva, Merck KGaA, iGenomix and Guerbet. JWL is supported by an NHMRC Centre of Research Excellence (GNT1099422).


  • Apgar score
  • cognition
  • epidemiology
  • school assessment


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