Do Patients Really Have to Choose Between Delayed Cord Clamping and Newborn Stem Cell Banking?

Parents face many decisions while planning for the birth of a baby. Deciding whether to delay cord clamping – and for how long – can be a tough decision because medical recommendations are evolving, and it’s easy to find contradicting information about the risks and benefits for both mom and baby. No wonder parents are often left confused and anxious about whether they’re making the right decision! On top of it all, many families want to privately bank newborn stem cells, which adds an additional layer of uncertainty. These families are often told that they need to choose between banking newborn stem cells and delaying cord clamping, but is that advice accurate?

The American College of Obstetricians and Gynecologists (ACOG) cites significant benefits in delaying cord clamping for preterm infants, including increases in hemoglobin levels at birth. They also note improved iron stores in the first several months of life for term infants. These benefits support their recommendation of delaying clamping by at least 30-60 seconds.1 The World Health Organization’s most recent recommendations state that a delay of 1-3 minutes should be performed for all births.2 The American College of Nurse Midwives recommends a delay of up to 5 minutes for term and preterm infants.3 While it seems that women’s health professional societies agree that there are benefits to delaying cord clamping, recommendations about timing vary. When making decisions about how long to delay clamping while also preserving newborn stem cells, a balanced approach is necessary.

The balance hinges on the fact that cord blood units used for medical treatments are dosed as a specific number of total nucleated cells (TNC) per kilogram of body weight. Since cord blood is a finite resource of the hematopoietic stem cells needed for a stem cell transplant, the amount collected directly impacts the clinical utility of the cord blood unit.

The New York Blood Center published a study after analyzing cord blood collections from 1,210 deliveries. In this study, cord blood units collected after a delay of more than 60 seconds had significantly lower volumes and TNC counts than when clamping occurred at less than 60 seconds.4 An abstract presented by a US family bank and a publication from a public bank in Canada showed similar results: both reported that longer delays resulted in smaller volume and lower TNC count cord blood collections.5,6

So what does this mean for parents who are interested in doing both delayed cord clamping and privately banking newborn stem cells?

Families may prioritize banking over delayed cord clamping when a family member has an immediate medical need for a stem cell transplant and the baby’s cord blood may be used. In this case, it would be essential to maximize the volume of blood and number of hematopoietic stem cells available for that lifesaving treatment; the family may feel that the benefits of saving the cells for a family member in need outweigh the benefits of delayed cord clamping for the baby. Delayed cord clamping is not advisable if a family chooses to donate cord blood to a public bank, since public banks have strict volume requirements for donated units. Family banks do not have the same volume requirements. If you or a parent would like guidance in a specific situation, CBR’s team of Clinical Specialists and Genetic Counselors are available to chat.

Many OB/GYN practices and hospitals in the U.S. follow ACOG’s guidance and delay cord clamping for 30-60 seconds. As described above, a delay of 30-60 seconds should not significantly impact the cell counts for cord blood collections. Families planning to delay this long can do so and should have sufficient cord blood for collection and family banking.

Midwives and Nurse Practitioners tend to recommend longer delays, in alignment with the recommendations from ACNM and WHO. In some cases, it may still be possible to delay clamping for up to minutes while still collecting enough cord blood to preserve with a family bank. In these situations, it is important to note that every cord blood sample sent to CBR is measured against our Quality Standard, which includes a minimum cell count. If a family wants to collect cord blood after a longer delay, they may do so and will be notified if the cord blood sample does not meet CBR’s Quality Standard.

For those families and providers who prefer to delay beyond two minutes, until the cord has stopped pulsing, or until the cord is blanched and there is minimal blood remaining, it is unlikely that a sufficient cord blood sample for banking will be collected. However, cord tissue banking is unaffected by delayed cord clamping, and families do have the option to bank only the cord tissue if preserving privately. This also provides the family with a different type of stem cell than what’s found in cord blood, with its own unique properties, and is a strong candidate for future regenerative medicine uses.

Ultimately, parents want to make the best choices they can for the health of their newborn, and when they are told that they have to choose between two beneficial options, it can be a difficult decision. The good news about delayed cord clamping and newborn stem cell banking is that families don’t have to choose. Doing both can allow the baby to reap the benefits of delayed cord clamping now and lock in the therapeutic potential of newborn stem cells for the future.

References

  1. Committee on Obstetric Practice. Committee Opinion No. 684: Delayed Umbilical Cord Clamping After Birth. Obstet Gynecol. 2017;129(1):e5-e10. doi:10.1097/AOG.0000000000001860
  2. WHO. Guideline: Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes. Geneva: World Health Organization; 2014.
  3. Position Statement. Delayed Umbilical Cord Clamping. American College of Nurse-Midwives; May 2014.
  4. Ciubotariu R, Scaradavou A, Ciubotariu I, et al. Impact of delayed umbilical cord clamping on public cord blood donations: can we help future patients and benefit infant donors?. Transfusion. 2018;58(6):1427-1433. doi:10.1111/trf.14574
  5. (2017), ICBS ABSTRACT. The Effect of Delayed Clamping on Umbilical Cord Blood Collection Volume and Total Nucleated Cell Count in the Family Banking Setting. Transfusion, 57: 1A-10A. doi:10.1111/trf.14207
  6. Allan, D.S., Scrivens, N., Lawless, T., Mostert, K., Oppenheimer, L., Walker, M., Petraszko, T. and Elmoazzen, H. (2016), Delayed clamping of the umbilical cord after delivery and implications for public cord blood banking. Transfusion, 56: 662-665. doi:10.1111/trf.13424
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