Can Apgar scores also predict maternal health?

Five-minute Apgar scores have long been a yardstick for assessing infant wellbeing at birth. The scores also may serve as an indicator of poor maternal health, say Canadian researchers in a research letter published in JAMA Pediatrics.

The authors based their conclusions on a study of 612,980 live singleton births in Ontario, Canada from April 2006 to March 2012. Their goal was to determine whether a low, intermediate, or normal newborn Apgar score at 5 minutes was associated with maternal postpartum intensive care unit (ICU) admission.

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The researchers stratified the births by preterm (24 to 36 weeks) versus term (≥37 weeks); hypertensive disorders in pregnancy; as well as the median interval between delivery and admission to the ICU. They used modified Poisson regression analysis to generate unadjusted and adjusted relative risks. Adjustments were made for maternal age, parity, income quintile, pre-pregnancy diabetes mellitus, obesity, drug dependence or tobacco use, and newborn sex.

The rate of maternal ICU admission was 1.7 per 1000 among mothers of neonates with normal 5-minute Apgar scores (7-10). As the scores fell, however, the rates of maternal ICU admission rose, to 13.0 per 1000 with an intermediate score (4 to 6) and 18.8 per 1000 for lower scores. The ICU admission rates were high among women who delivered preterm or had a hypertensive disorder, but the adjusted relative risk was more pronounced in term births or in the absence of hypertensive disorders. In addition, the adjusted relative risks were higher among women who were admitted to the ICU within 4 hours of delivery.

“A low 5-minute Apgar score,” the authors said, “reflects a higher risk of maternal ICU admission with and without mechanical ventilation.” They recommend, as a next step, assessing whether use of Apgar scores can improve the performance of models that are used to predict severe, acute maternal morbidity.

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How reproductive events signal future health

According to a new analysis in BMC Medicine, the timing of reproductive events such as age at first menarche and at first birth may serve as an indicator of a woman’s long-term overall health.

Researchers performed the analysis within the European Investigation into Cancer and Nutrition prospective cohort study, which enrolled 322,972 women aged 25 to 70 from 10 European countries. Reproductive characteristics assessed at baseline in 1992 and followed for a mean of 12.9 years included parity, age at first birth, history of breastfeeding, infertility, oral contraceptive (OC) use, age at both menarche and menopause, total ovulatory years, and history of oophorectomy/hysterectomy.

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The authors calculated hazard ratios (HRs) and 95% confidence intervals (CI) for the women’s mortality using Cox proportional hazards regression models that adjusted for menopausal status, body mass index, physical activity level, education level, and smoking status/intensity and duration.

Over the course of the study, 14,383 of the women died. The HR for risk of all-cause mortality was lower in parous women than it was in nulliparous women (.80; 0.76-0.84) and in those who had breastfed than in women who had not (.92; 0.87-0.97). Nonsmokers who had ever used OCs (0.90; 0.86-0.95) and women who reported starting menarche after age 15 versus before age 12 (0.90; 0.85-0.96; P for trend = 0.038) also had a lower overall risk of death.

Investigators concluded that childbirth, breastfeeding, OC use, and later menarche were tied to overall better health outcomes for women. They believe that the findings may contribute to the development of programs to better promote long-term health in women.

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A place for ultrasound in breast cancer detection?

According to a Japanese randomized trial, the addition of ultrasound to mammography may lead to more sensitive screening for a higher rate of detection of early breast cancers.

Between July 2007 and March 2011, the researchers enrolled asymptomatic women between 40 to 49 years at 42 study sites located in 23 prefectures across Japan in the Japan Strategic Anti-cancer Randomized Trial. The women had no history of cancer in the 5 years prior to enrollment and were expected to live for more than 5 years.

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Participants were randomly assigned in a 1:1 ratio to either mammography and ultrasonography or mammography alone twice in 2 years. Of the 72,998 women in the study, 36,859 were assigned to the intervention group and 36,139 to the control group.

The investigators found that sensitivity was significantly higher in the intervention group (91.1%) than in the control group (77.0%), but specificity was higher in the control group (91.1%) than in the intervention group (87.3%). The intervention group also had more cancers detected than did the control group (184 vs 117, P = 0.0003) and the disease was more often stage 0 or I (144 vs 79, P = 0.0194). In addition, 18 interval cancers were found in the intervention group compared to 35 in the control group.

The researchers concluded that using ultrasound in addition to mammography could increase the sensitivity and detection of early cancers.