Cnattingius S, et al. - Based on the Stockholm‐Gotland Obstetrical Database, covering all antenatal, obstetric, and neonatal care within the counties of Stockholm and Gotland, Sweden, researchers conducted this population‐based cohort study to explore connections between metabolic acidosis (defined as pH <7.05 or <7.10 and base deficit ≥12) and risks of Apgar scores of 7, 8, and 9 at 5 and 10 minutes, as well as to estimate the joint impact of metabolic acidosis and Apgar score values within the normal range (7‐10), with respect to risk of neonatal morbidity. The adjusted RR of an Apgar score of 9 at 5 minutes was 3.14 in infants with metabolic acidosis as opposed to infants without metabolic acidosis, and 10.13 and 7.60 for Apgar scores of 8 and 7, respectively. In addition, corresponding RRs of Apgar scores at 10 minutes were substantially increased. The magnitude of RDs differed but consistently increased. Neonatal morbidity was affected by both decreased Apgar scores and metabolic acidosis (pH < 7.10). Findings suggested an association of metabolic acidosis with increased risks of reduced Apgar scores within the normal range. The findings need to be verified in other populations due to international variations in the assessment of the Apgar score.