LLLI Center for Breastfeeding Information

Journal Abstract of the Month for October 2006

“Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial”

Authors: Chaparro, Camila M., Lynnette M. Neufeld, Gilberto Tena Alavez, Raul Eguia-Liz Cedillo, and Kathryn G. Dewey

The Lancet 367.9527 (June 17, 2006): 1997(8).

Abstract:

Metabolic iron stores in the breastfed infant have always been of great concern. Until this time, it has been thought that the healthy, exclusively-breastfed infant should not, under normal circumstances, require dietary iron fortification prior to the 6th month of life. However, this study on the timing of umbilical cord clamping reveals some interesting information that may impact our previous understanding of how an infant’s iron stores are created and kept during those first few months.

In this study, pairs of mothers and infants who delivered vaginally and who lacked risk factors associated with impaired iron efficiency were placed into two randomly selected groups. In the control group (“early”), the baby’s umbilical cord was clamped between 10 and 20 seconds after shoulder delivery (the current standard of care in many parts of the world). In the study group (“late”), the cord was clamped between 90 and 100 seconds after delivery, during which time the baby was held at uterine height. Various blood tests were performed on the baby at 3-month intervals during the first year; the mother’s iron levels were also checked. It was found that babies whose cords were clamped late were more likely to have and to maintain, for at least 3 months, higher levels of iron in their blood than were babies whose cords were clamped early. Significantly, however, the higher blood iron levels were less likely to be found in infants whose mothers demonstrated a deficiency in their own iron levels.

What does this mean for the position that iron supplementation is not necessary following birth in the breastfed baby during the first half of the first year, prior to the introduction of iron-fortified foods? It may need to be qualified. The risks to the infant of dietary iron supplementation binding in the gut and keeping the more bioavailable iron of the breast milk from entering the bloodstream still exist. However, this study seems to show that there is a stronger link between the mother’s iron levels and the baby’s than was previously suspected. Combined with the current changes in guidelines reducing the amount of iron supplementation recommended for healthy pregnant women, we may see an increase in the number of infants with lower iron stores who then require supplementation.

The logical conclusions one must draw are that iron levels in both mother and baby should be monitored closely before and after delivery; that if the mother presents with iron deficiency or iron deficiency anemia during pregnancy, she should be supplemented in the hope of raising her baby’s iron stores in utero; that delaying cord clamping in the delivery room until 1.5-2 minutes have passed (roughly until the cord stops pulsing at between 1 and 3 minutes) while holding the baby at uterine height can significantly increase the neonatal stores of iron in the baby’s body during the first 3 months of life; and that breast milk still provides the metabolically perfect form of iron, which should only be supplemented in the presence of proof of the baby’s depleted iron stores.

This paper is categorized by the following keywords:

Anemia
Iron
Umbilical cord

The full text of this article is available (for a fee) at:
http://www.nlm.nih.gov/loansomedoc/loansome_home.html

Past Journal Abstracts of the Month