Timing of umbilical cord-clamping and infant anaemia: the role of maternal anaemia.
BACKGROUND
Evidence from randomized controlled trials has shown that delayed cord-clamping is beneficial to infant iron status. The role of maternal anaemia in this relationship, however, has not been established.


OBJECTIVE
To determine the effect of maternal anaemia at delivery on the association between timing of umbilical cord-clamping and infant anaemia at 4 and 8 months of age.


METHODS
A cohort of pregnant women admitted to the labour room of Hospital Iquitos (Iquitos, Peru) and their newborns were recruited into the study during two time periods (18 May to 3 June and 6-20 July 2009). Between the two recruitment periods, the hospital's policy changed from early to delayed umbilical cord-clamping. Maternal haemoglobin levels were measured before delivery, and the time between delivery and cord-clamping was recorded at delivery for the entire cohort. Mother-infant pairs were followed-up at 4 (n = 207) and 8 months (n = 184) post partum. Infant haemoglobin levels were measured at follow-up visits. Data were analysed using logistic regression models.


RESULTS
The prevalence of maternal anaemia (Hb <11.0 g/dl) at delivery was 22%. Infant haemoglobin levels at 4 and 8 months of age were 10.4 g/dl and 10.3 g/dl, respectively. Infant haemoglobin levels did not differ significantly between infants born to anaemic mothers and those born to non-anaemic mothers at either 4 or 8 months of age. However, the association between the timing of cord-clamping and infant anaemia was modified by the mother's anaemia status. Significant benefits of delayed cord-clamping in preventing anaemia were found in infants born to anaemic mothers at both 4 months (aOR = 0.59, 95% CI 0.36-0.99) and 8 months (aOR = 0.38, 95% CI 0.19-0.76) of age.


CONCLUSIONS
The study contributes additional evidence in support of delayed cord-clamping. This intervention is likely to have most public health impact in areas with a high prevalence of anaemia during pregnancy.
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
Brittany
B
Blouin
Mary E
ME
Penny
Mathieu
M
Maheu-Giroux
Martín
M
Casapía
Eder
E
Aguilar
Hermánn
H
Silva
Hilary M
HM
Creed-Kanashiro
Serene A
SA
Joseph
Anita
A
Gagnon
Elham
E
Rahme
Theresa W
TW
Gyorkos
D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000453:epidemiology*; D015331:Cohort Studies; D003250:Constriction; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010568:Peru / Q000453:epidemiology; D011247:Pregnancy; D015995:Prevalence; D013997:Time Factors; D014470:Umbilical Cord; D055815:Young Adult
D006454:Hemoglobins