The predictive value of the Apgar score for morbidity and mortality for newborns born to women with hypertensive disorders during pregnancy in Ghana: a prospective cohort study.

Abstract

Background: A child born in sub-Saharan Africa is ten times more likely to die in the first month than a child born in a high-income country. The Apgar-score was developed to reduce infant mortality and morbidity through early detection of complications. Despite its widespread use, the accuracy of the predictive value of the Apgar-score for morbidity and mortality in low- and middle-income countries has scarcely been evaluated. None focused on newborns born to women with severe hypertensive disorders during pregnancy, while this is a major reason for neonatal mortality and morbidity. Aim: To determine the predictive value of the five-minute Apgar-score for morbidity and mortality in newborns born to women who experienced severe hypertensive disorders during pregnancy and were admitted to referral hospitals in Ghana. Method: A secondary data analysis was performed on data collected between December 2017 and March 2021 within a prospective cohort study (SPOT study) in six major obstetric care centres in Ghana. The study population consists of newborns born to women who experienced hypertensive disorders during pregnancy in Ghana. Multivariable logistic regression analyses and a receiver operating characteristic (ROC) curve were used to determine the predictive value of the five-minute Apgar-score.

Results: In total, 565 newborns were included. Univariate logistic regression analyses found an association between Apgar-score and all neonatal adverse events (OR between 1.32-2.23). In the multivariate logistic regression analysis only NICU-admission lost the association with Apgar-score. The ROC (univariate) indicated an acceptable to good discriminative ability (AUC between 0.67-0.78) for all neonatal adverse outcomes. The multivariate AUC slightly increased compared to the univariate model (AUC between 0.72-0.79).

Conclusion and Recommendations: The five-minute Apgar-score could be used as a warning sign for all adverse outcomes. Future research is needed to refine the prediction model further.