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



Prospective observational study with historical control.



Swedish county hospital.



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



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



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.



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.



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.
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.|Department of Research and Development, Region Halland, Sweden.
Ola
0000-0002-3972-0457
O
Andersson
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Lena
L
Hellström-Westas
Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
Magnus
M
Domellöf
D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology*; D002585:Cesarean Section / Q000009:adverse effects*; D003250:Constriction; D017558:Elective Surgical Procedures; D004909:Erythrocyte Indices; D005260:Female; D005293:Ferritins / Q000097:blood*; D006454:Hemoglobins / Q000032:analysis; D065386:Historically Controlled Study; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007501:Iron / Q000097:blood*; D011247:Pregnancy; D011446:Prospective Studies; D013548:Sweden; D013997:Time Factors; D014470:Umbilical Cord / Q000098:blood supply*
D006454:Hemoglobins; D005293:Ferritins; D007501:Iron
caesarean section; cord clamping; iron deficiency; pregnancy; umbilical cord; vaginal birth