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BMJ Open. 2016 Nov 2;6(11):e012995. doi: 10.1136/bmjopen-2016-012995.

Elective caesarean: does delay in cord clamping for 30 s ensure sufficient iron stores at 4 months of age? A historical cohort control study.

Author information

1
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
2
Department of Research and Development, Region Halland, Sweden.
3
Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.

Abstract

OBJECTIVE:

To compare iron stores in infants born after elective caesarean section (CS) and a 30 s delay of umbilical cord clamping with those born vaginally after early (≤10 s) or delayed (≥180 s) cord clamping.

DESIGN:

Prospective observational study with historical control.

SETTING:

Swedish county hospital.

POPULATION:

64 infants born after elective CS were compared with a historical control of 166 early clamped and 168 delayed clamped after vaginal birth.

METHODS:

Blood and iron status were measured in blood samples collected at birth, 48-96 hours after birth, 4 and 12 months of age.

PRIMARY AND SECONDARY OUTCOME MEASURES:

Ferritin at 4 months of age was the primary outcome, second outcome measures were other indicators of iron status, and haemoglobin, at 4 and 12 months of age, as well as respiratory distress at 1 and 6 hours after birth.

RESULTS:

At 4 months infants born by elective CS had better iron status than those born vaginally subjected to early cord clamping, shown by higher adjusted mean difference of ferritin concentration (39 µg/L (95% CI 10 to 60)) and mean cell volume (1.8 fL (95% CI 0.6 to 3.0)); and lower levels of transferrin receptors (-0.39 mg/L (95% CI -0.69 to -0.08)). No differences were seen between infants born after elective CS and delayed clamped vaginally born infants at 4 months. No differences were found between groups at 12 months of age.

CONCLUSIONS:

Waiting to clamp the umbilical cord for 30 s after elective CS results in higher iron stores at 4 months of age compared with early cord clamping after vaginal birth, and seems to ensure iron status comparable with those achieved after 180 s delayed cord clamping after vaginal birth.

KEYWORDS:

caesarean section; cord clamping; iron deficiency; pregnancy; umbilical cord; vaginal birth

PMID:
27807089
PMCID:
PMC5129052
DOI:
10.1136/bmjopen-2016-012995
[Indexed for MEDLINE]
Free PMC Article

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