Association between 5-min Apgar score and attention deficit hyperactivity disorder: a Scotland-wide record linkage study of 758,423 school children

Bala, J. J., Bala, J. D., Pell, J. P. and Fleming, M. (2023) Association between 5-min Apgar score and attention deficit hyperactivity disorder: a Scotland-wide record linkage study of 758,423 school children. BMC Psychiatry, 23, 794. (doi: 10.1186/s12888-023-05217-6) (PMID:37907891) (PMCID:PMC10619264)

Abstract

Background: Attention-deficit hyperactivity disorder (ADHD) affects around 1 in 20 children and is associated with life-long sequelae. Previous studies of the association between Apgar score and ADHD have reported inconsistent findings. Methods: Record linkage of maternity, prescribing and school pupil census databases was used to conduct a population e-cohort study of singleton children born in Scotland and attending school in Scotland at any point between 2009 and 2013. Binary logistic regression analysis was used to investigate the association between 5-min Apgar score and treated ADHD adjusting for sociodemographic and maternity confounders. Results: Of the 758,423 children, 7,292 (0.96%) received ADHD medication. The results suggested a potential dose–response relationship between Apgar score and treated ADHD independent of confounders. Referent to an Apgar score of 10, risk of treated ADHD was higher for scores of 0–3 (adjusted OR 1.76, 95% CI 1.32–2.34), 4–6 (adjusted OR 1.50, 95% CI 1.21–1.86) and even 7–9 (adjusted OR 1.26, 95% CI 1.18–1.36) which are traditionally considered within the normal range. Conclusions: In addition to reinforcing the need to maximise Apgar score through good obstetric practice, the findings suggest that Apgar score may be useful in predicting future risk of ADHD and therefore facilitating early diagnosis and treatment.

• Item Type: Articles
• Additional Information: The study was sponsored by Health Data Research UK (www.hdruk.ac.uk) which is a joint investment led by the Medical Research Council, together with the National Institute for Health Research (England), the Chief Scientist Office (Scotland), Health and Care Research Wales, Health and Social Care Research and Development Division (Public Health Agency, Northern Ireland), the Engineering and Physical Sciences Research Council, the Economic and Social Research Council, the British Heart Foundation and Wellcome (grant reference number MR/S003800/1).
• Keywords: Apgar score, attention deficit disorder with hyperactivity, cohort studies, education, medical record linkage.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Pell, Professor Jill and Fleming, Dr Michael
• Authors: Bala, J. J., Bala, J. D., Pell, J. P., and Fleming, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: BMC Psychiatry
• Publisher: BioMed Central
• ISSN: 1471-244X
• ISSN (Online): 1471-244X
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in BMC Psychiatry 23: 794
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
303197		Linking education and health data together to study relationships between various health factors and children's educational and health outcomes	Jill Pell	Medical Research Council (MRC)	MR/S003800/1	SHW - Public Health