title: Impact of maternal education level on risk of low Apgar score.
abstract: OBJECTIVE
  To investigate the association between 5-min Apgar score and socio-economic characteristics of pregnant women, particularly education level.
  
  
  METHODS
  Population-based cross-sectional study.
  
  
  METHODS
  This study used hospital records of live term singleton births in Brazil from 2004 to 2009, obtained from the Ministry of Health National Information System. Crude and adjusted odds ratios (ORs) were used to estimate the risk of a low 5-min Apgar score (≤6) associated with maternal education level, maternal age, marital status, primiparity, number of prenatal visits and mode of delivery (vaginal/caesarean section).
  
  
  RESULTS
  Nearly 12 million records were analysed. Births from mothers with 0, 1-3, 4-7 and 8-11 years of education resulted in crude ORs for low 5-min Apgar score of 3.1, 2.2, 1.8 and 1.3, respectively (reference: ≥12 years of education). The crude OR for mothers aged ≥41 years (reference 21-34 years) was 1.4, but no risk was detected for those with ≥12 years of education and those who gave birth by caesarean section (OR 1.0 [95% confidence interval 0.9-1.2]). Generally, the risk of a low 5-min Apgar score was found to increase as maternal age moved away from 21 to 34 years (OR 1.1-1.7), and for mothers with the same characteristics, the risk of a low 5-min Apgar score was found to decrease markedly as education level increased (adjusted OR decreased from 2.6 to 1.2).
  
  
  CONCLUSIONS
  Maternal education level is clearly associated with the risk of a low 5-min Apgar score.
authors.affiliation: Department of Statistics, Fluminense Federal University, Niterói, RJ, Brazil.
authors.forename: N K O
authors.initials: NKO
authors.lastname: Almeida
authors.affiliation: Systems & Computing Department, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors.forename: C E
authors.initials: CE
authors.lastname: Pedreira
authors.affiliation: Program of Biomedical Engineering, COPPE, Federal University of Rio de Janeiro, RJ, Brazil. Electronic address: renan@peb.ufrj.br.
authors.forename: R M V R
authors.initials: RMVR
authors.lastname: Almeida
mesh_terms: D000293:Adolescent; D000328:Adult; D001034:Apgar Score; D001938:Brazil; D002648:Child; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008875:Middle Aged; D009035:Mothers / Q000706:statistics & numerical data*; D011247:Pregnancy; D012307:Risk Factors; D055815:Young Adult
keywords: Apgar score; Maternal education; Newborn outcome