The effect of unwanted pregnancies on neonatal Apgar scores: A prospective cohort study]

We studied 1800 pregnant women receiving routine prenatal care in the urban and rural health centers of Shahr-e-Rey in south of Tehran, for a comparative assessment of 5-minute neonatal Apgar Scores in wanted versus unwanted pregnancies. The subjects were studied in 2 groups, each comprising 900 pregnant women. Group A consisted of mothers with wanted pregnancy and group B of mothers with unwanted pregnancy. Inclusion criteria were gestational age less than 28 weeks at the time of entering the study. The two groups were followed through their prenatal care to the time of delivery. For each neonate, we extracted the 5-minute Apgar score from the birth certificate.For a more precise assessment, the impact of conditions affecting the Apgar score of newborns (such as normal vaginal delivery vs. caesarean section, premature birth, low birth weight, congenital anomalies, and birth place (hospital and health center, or house) was assessed by logistic regression. We found 15 cases (0.4%) of low 5-minute Apgar score (under 8) among newborns of wanted pregnancies and 4 such cases (1.1%) among those of unwanted pregnancies. The difference between the 2 groups was significant (P= 0.011). After applying the logistic regression model to adjust for other factors, unwanted pregnancies still had a significant association with low Apgar scores (increasing the risk 3-fold).The attributable risk for low 5-minute Apgar score in unwanted pregnancies was 0.54 (CI.95 = 0.132 to 0.813). The estimated attributable risk means that with 95% confidence, between 13.2% and 81.3% of the low Apgar scores could have been prevented by eliminating unwanted pregnancy. As there have been no similar studies in Iran, more research with larger samples must be performed to assess these results more precisely.