Epidemiology and region-specific risk factors for low Apgar scores in China: a nationwide study

Background Neonatal asphyxia is a serious public health issue. This study aimed to determine the epidemiology and region-specific risk factors for low Apgar scores, an important proxy for neonatal asphyxia, in China from 2015 to 2016. Methods The China Labor and Delivery Survey was a multicenter cross-sectional study including 96 hospitals distributed in 24 (out of 34) provinces. Logistic regression analysis was performed to examine the risk factors for a low Apgar score (< 7). Correspondence analyses were performed among neonates with low Apgar scores to explore the relationship between risk factors and geographical regions. The population attributable risk percentage (PAR%) was calculated for each region-specific risk factor. Results A total of 72,073 live births, including 320 births with low Apgar scores, were used for the analysis, giving a weighted rate of 3.9/1000 live births. There was a substantial difference in the incidence of low Apgar scores by geographic region, from 2.3/1000 live births in East China to 10.9/1000 live births in Northeast China. Maternal and obstetric factors are the major region-specific risk factors. In Southwest China, hypertensive disorders in pregnancy were more important contributors, with PAR% being 74.47%; in North and Northwest China, pre-pregnancy underweight was a more significant factor, with PAR% of 62.92%; in East China, infants born between 0:00 a.m. and 7:59 a.m. were a key factor, with PAR% of 80.44%. Conclusion Strategies based on region-specific risk factors should be considered to reduce the burden of low Apgar scores in China.

Automated summary

The study revealed significant regional disparities in the incidence of low Apgar scores in China, with maternal and obstetric factors being the major region-specific risk factors. Developing strategies based on region-specific risk factors may help reduce the burden of low Apgar scores in China.