Delaying cord clamping reduces iron deficiency in infants

Delaying clamping of the umbilical cord until 3 minutes or longer after delivery reduces neonatal anemia and iron deficiency at 4 months of age without adverse effects, according to a Swedish study.

The randomized controlled trial, published online November 15 in the clinical research edition of the British Medical Journal, enrolled 400 full-term infants born after low-risk pregnancy at a Swedish county hospital. Investigators randomized the babies to delayed umbilical cord clamping (≥180 seconds after delivery) or early clamping (≤10 seconds after delivery) and measured hemoglobin and iron status at 4 months of age. The delayed and early cord clamping groups showed no significant differences between groups in hemoglobin concentration at 4 months but the delayed group had a 45% higher mean ferritin concentration and lower prevalence of iron deficiency than the early group.

Researchers assessed neonatal anemia, early respiratory symptoms, polycythaemia, and hyperbilirubinemia requiring phototherapy as secondary outcomes and found no significant differences between the delayed and early clamping groups. However, “delayed clamping also reduced the incidence of neonatal anemia at 2 days of age without increasing the rate of respiratory symptoms or need for phototherapy,” the researchers write.

Noting that the study’s findings on infants in a high-income country are similar to results from two meta-analyses in low or middle income countries with a high general prevalence of anemia, the researchers posit that “our results suggest that delayed cord clamping also benefits infant health in regions with a relatively low prevalence of iron deficiency and should be considered as standard care for full-term deliveries after uncomplicated pregnancies.” They point out that iron deficiency even without anemia has been linked to impaired infant development.

The authors caution that the findings of the study, which comprised only full-term, low-risk deliveries by healthy mothers from a well-nourished population, may not be generally applicable to term babies with perinatal risk factors such as maternal diabetes or intrauterine growth restriction.

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