Apgar score and risk of autism.
Apgar score and risk of autism.
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DOI：
10.1007/s10654-018-0445-1
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发表时间：
2019-03
影响因子：
13.6
通讯作者：
Reichenberg A
中科院分区：
文献类型：
--
作者：
Modabbernia A;Sandin S;Gross R;Leonard H;Gissler M;Parner ET;Francis R;Carter K;Bresnahan M;Schendel D;Hornig M;Reichenberg A
低Apgar评分与几种神经和精神疾病的高风险相关，包括脑瘫和智力残疾。关于Apgar评分与自闭症谱系障碍（ASD）之间关系的研究一直不一致。我们的目的是研究(1)5分钟低Apgar评分与ASD风险之间的关系，以及(2)胎龄和性别对这种关系的影响。我们纳入了来自挪威、瑞典、丹麦和西澳大利亚的550万人和33000多例自闭症患者的前瞻性数据，他们出生于1984年至2007年之间。我们以95%置信区间（95% ci）计算低Apgar评分与ASD之间的关联的粗风险比（RR）和校正风险比（RR）。自闭症障碍（AD）的所有分析都是重复的。我们使用相互作用术语和分层分析来调查性别、胎龄和出生体重对这种关联的影响。在完全调整后的模型中，低Apgar评分（1-3）（RR, 1.42; 95% CI, 1.16-1.74）和中等Apgar评分（4-6）（RR, 1.50; 95% CI, 1.36-1.65）与最佳Apgar评分（7-10）相比，ASD的RR更高。AD的低Apgar评分（RR, 1.88; 95% CI, 1.41-2.51）和中等Apgar评分（RR, 1.54; 95% CI, 1.32-1.81）的点估计值大于ASD。这项研究表明，低Apgar评分与ASD，特别是AD的高风险相关。我们没有观察到胎龄和性别的任何主要改变作用，尽管胎龄和出生体重似乎在观察到的关联中存在大量混淆。本文的在线版本（10.1007/s10654-018-0445-1）包含补充材料，授权用户可使用。
Low Apgar score has been associated with higher risk for several neurological and psychiatric disorders, including cerebral palsy and intellectual disability. Studies of the association between Apgar score and autism spectrum disorder (ASD) have been inconsistent. We aimed to investigate (1) the association between low Apgar score at 5 min and risk for ASD, and (2) the modifying effects of gestational age and sex on this association in the largest multinational database of ASD. We included prospective data from 5.5 million individuals and over 33,000 cases of ASD from Norway, Sweden, Denmark and Western Australia who were born between 1984 and 2007. We calculated crude and adjusted risk ratios (RR) with 95% confidence intervals (95% CIs) for the associations between low Apgar score and ASD. All analyses for ASD were repeated for autistic disorder (AD). We used interaction terms and stratified analysis to investigate the effects of sex, gestational age, and birth weight on the association. In fully adjusted models, low Apgar scores (1–3) (RR, 1.42; 95% CI, 1.16–1.74), and intermediate Apgar scores (4–6) (RR, 1.50; 95% CI, 1.36–1.65) were associated with a higher RR of ASD than optimal Apgar score (7–10). The point estimates for low (RR, 1.88; 95% CI, 1.41–2.51) and intermediate Apgar score (RR, 1.54; 95% CI, 1.32–1.81) were larger for AD than for ASD. This study suggests that low Apgar score is associated with higher risk of ASD, and in particular AD. We did not observe any major modifying effects of gestational age and sex, although there seems to be substantial confounding by gestational age and birth weight on the observed association. The online version of this article (10.1007/s10654-018-0445-1) contains supplementary material, which is available to authorized users.
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