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This study investigated trends of these perinatal health indicators in Germany. Perinatal data on 10,696,831 in-hospital live births from 2008 to 2022 were obtained from quality assurance institutes. Joinpoint regression analysis was used to quantify trends of low Apgar score and UA pH. Additional analyses stratified by mode of delivery were performed on term singletons with cephalic presentation. Robustness against unmeasured confounding was analyzed using the <jats:italic>E<\/jats:italic>-value sensitivity analysis. The overall rates of 5-min Apgar scores\u2009&lt;\u20097 and UA pH\u2009&lt;\u20097.10 in liveborn infants were 1.17% and 1.98%, respectively. For low Apgar scores, joinpoint analysis revealed an increase from 2008 to 2011 (annual percent change (APC) 5.19; 95% CI 3.66\u20139.00) followed by a slower increase from 2011 to 2019 (APC 2.56; 95% CI 2.00\u20133.03) and a stabilization from 2019 onwards (APC\u2009\u2212\u20090.64; 95% CI\u2009\u2212\u20093.60 to 0.62). The rate of UA blood pH\u2009&lt;\u20097.10 increased significantly between 2011 and 2017 (APC 5.90; 95% CI 5.15\u20137.42). For term singletons in cephalic presentation, the risk amplification of low Apgar scores was highest after instrumental delivery (risk ratio 1.623, 95% CI 1.509\u20131.745), whereas those born spontaneous had the highest increase in pH\u2009&lt;\u20097.10 (risk ratio 1.648, 95% CI 1.615\u20131.682).<\/jats:p><jats:p><jats:italic>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Conclusion<\/jats:italic>: Rates of low 5-min Apgar scores and UA pH in liveborn infants increased from 2008 to 2022 in Germany.<jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is Known:<\/jats:bold><jats:italic>\u2022 Low Apgar scores at 5 min after birth and umbilical arterial blood pH are associated with adverse perinatal outcomes.<\/jats:italic><jats:italic>\u2022 Prospective collection of Apgar scores and arterial blood pH data allows for nationwide quality assurance.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is New:<\/jats:bold><jats:italic>\u2022 The rates of liveborn infants with 5-min Apgar scores &lt; 7 rose from 0.97 to 1.30% and that of umbilical arterial blood pH &lt; 7.10 from 1.55 to 2.30% between 2008\u20132010 and 2020\u20132022. <\/jats:italic><jats:italic>\u2022 In spontaneously born term singletons in cephalic presentation, the rate of metabolic acidosis with pH &lt; 7.10 and BE &lt; \u22125 mmol\/L in umbilical arterial blood roughly doubled between the periods 2008\u20132010 and 2020\u20132022.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-024-05475-w","type":"journal-article","created":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T11:03:25Z","timestamp":1708167805000},"page":"2163-2172","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Trends in Apgar scores and umbilical artery pH: a population-based cohort study on 10,696,831 live births in Germany, 2008\u20132022"],"prefix":"10.1007","volume":"183","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6895-4861","authenticated-orcid":false,"given":"Vinzenz","family":"Boos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"B\u00fchrer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,17]]},"reference":[{"issue":"4","key":"5475_CR1","first-page":"260","volume":"32","author":"V Apgar","year":"1953","unstructured":"Apgar V (1953) A proposal for a new method of evaluation of the newborn infant. 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