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Lower Apgar scores and Caesarean sections are related to attention-deficit/hyperactivity disorder

Acta Pediatrica, 05/04/2018

S ucksdorff M, et al. - In this population-based study, experts gauged the correlations between prenatal, birth-related and newborn risk factors and attention-deficit/hyperactivity disorder (ADHD) in subjects born between 1 January 1991 and 31 December 2005. The inference drawn was that elective Caesareans and perinatal adversities giving rise to lower Apgar scores increased the risk of ADHD.


  • The enrollment comprised of 10,409 subjects diagnosed with ADHD by 31 December 2011 and 39 124 controls, born between 1 January 1991 and 31 December 2005, using Finnish nationwide registers.
  • Perinatal data were extracted from the Birth Register.
  • Conditional logistic regression assisted in evaluating the correlations after controlling for confounders.


  • A connection was brought to light between lower Apgar scores with a higher risk of ADHD, with odds ratios of 1.12 (95% confidence intervals 1.06-1.19) for one-minute Apgar scores of 7-8, 1.17 (95% CI 1.02-1.35) for scores of 5-6 and 1.41 (95% CI 1.18-1.68) for scores of 0-4, compared to Apgar scores of 9-10.
  • Findings demonstrated that elective Caesarean sections correlated with an increased risk of ADHD with an adjusted odds ratio of 1.15 (95% CI 1.05-1.26).
  • Breech presentation, induced labour and admission to a Neonatal Intensive Care Unit served as other identified risk factors.
  • It was found that low umbilical artery pH did not raise the risk of ADHD.