As medical science advances, more and more pregnant women and their families are pondering a new question as they prepare to deliver: should I save my baby’s umbilical cord blood?
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Nikola A. Letham, DO, an OBGYN, has guided numerous patients through the process of cord blood banking. He’s interested in helping women and families become aware of the ins and outs of the procedure so they can make a decision that is right for them.
What is cord blood and why is it valuable?
The blood that remains in the umbilical cord and placenta after the baby’s delivery is a source of stem cells, technically called “hematopoietic stem cells.” Because of their regenerative power, these cells have the potential to develop into a variety of tissues in the body, and they can be used to treat certain diseases, including blood and immune disorders. They also have the benefit of being more versatile and better tolerated in patients than transplants of conventional bone marrow.
While the cord blood, umbilical cord and placenta are typically discarded after your child is born, you may choose to preserve (or “bank”) the blood in hopes it may be used to treat diseases in the future.
How is cord blood banked?
Sometime in the third trimester, if you’ve decided to bank your baby’s cord blood, you’ll order a special kit that contains everything your healthcare provider will need to preserve the sample.
“When the patient comes to the hospital, along with bringing the kit, they need to make the staff aware that it’s their intention to do cord blood banking,” says Dr. Letham.
Immediately after your baby is born, your OBGYN or midwife will clamp the umbilical cord, clean it, and draw out a portion of blood – 40 milliliters or more. “Some of the cord blood banking companies also allow for a segment of the umbilical cord to be collected as an additional source of stem cells,” says Letham.
The blood and sample (if taken) are then preserved in the kit, and the cord blood bank will make arrangements to have the kit shipped back.
If you elect to donate your baby’s cord blood to a public bank (more on that below), you’ll have alerted the bank and your doctor before your arrival at the hospital, and during your hospital stay. The public bank will usually take care of shipping your sample.
Blood and tissues samples may be drawn either before or after the placenta is delivered, but in either case, the utmost care should be taken to ensure that the procedure does not interfere with the delivery of the baby. Cord blood can be extracted regardless of whether you’ve had a vaginal birth or a cesarean section.
What types of cord blood banking are there?
There are two main types: public and private.
Public banks collect and store cord blood for use by anyone with a medical condition that may benefit from a blood stem cell transplant. Some hospitals throughout the country are certified to participate in public banking, so if you would like to donate cord blood to a public bank, you should verify beforehand whether your hospital and doctor participate.
As of 2017, there were 28 public cord banks in operation in North America. Some states require doctors to inform their patients about the public cord blood banking options available to them, while others do not.
When you donate a sample to a public bank, it becomes anonymized, so there is no way to trace the blood back to you or your child. “All the maternal information is shielded,” says Letham.
There is no cost to you to donate cord blood to a public bank. “But it’s important to recognize that as a patient doing public cord blood banking, you're not guaranteed access to those stem cells down the road,” Letham says. “They’re in the public domain.”
Private cord blood banks, on the other hand, are for-profit companies that enable you to save a portion of your newborn’s cord blood for the exclusive use of your child, other family members or anyone else to whom you wish to donate the blood in case it’s needed in the future.
This privilege comes at a price. In addition to an initial fee that can run upwards of $2,000, you pay a yearly storage fee that ranges from $100 to $175 per sample. Such fees are not typically covered by insurance.
For families confronting an immediate medical crisis, however, there is a third option. Some banks, both public and private, may offer a related type of service known as “directed,” “family-directed” or “sibling” cord blood banking. This is designed for families with children or family members who presently have a disease that could be treated with a stem cell transplant from the cord blood of a child they are expecting. These directed banks are typically free of charge for families in need.
Can anyone donate cord blood?
Generally speaking, any family that wishes to – and has the financial means – may privately bank. Public banks, meanwhile, screen samples to ensure that they will be safe for use by others.
A questionnaire is typically used to screen public bank donors for certain infectious, inherited and genetic diseases, as well as conditions that could be transmitted by blood. While in the hospital, the mother’s blood is also tested for diseases such as hepatitis B or C, HIV, malaria and syphilis.
Should I store my baby’s cord blood?
It’s important to remember that banking your baby’s cord blood is entirely optional. It should only be done in a way that doesn’t interfere with the care that is required to ensure the safe delivery of your baby and your recovery from childbirth.
It’s also important to contemplate in detail the differences between public and private banks.
“If your hospital has a program and your doctors participate, there's probably no downside to doing public cord banking,” says Letham. “You can think of it as doing a public service, potentially helping somebody else with really no effort on your behalf.”
And, should your family ever be on the other side of the equation – in need of a cord blood donation from a public bank – the National Marrow Donor Program’s Be the Match service can help you find it.
Important considerations for private banking
According to the American College of Obstetricians and Gynecologists (ACOG), it’s important to understand that using private banking to store your child’s cord blood to potentially treat diseases he or she may develop later in life may not be effective because those cells may have the same problems that contributed to their illness in the first place.
In other words, if your child should develop leukemia later in life, his or her stored cord blood would likely contain premalignant cells.
You should also recognize that the odds of actually using a stored cord blood sample for a member of your own family in the future are very slim, estimated to be about 1 in 2,700.
To put the numbers into further perspective, there are an estimated 5 million cord blood units stored in private cord blood banks, and an estimated 800,000 in public banks, but cord blood stem cells from public banks are used at a rate 30 times higher than those stored in private banks.
For reasons such as these, the ACOG and the American Academy of Pediatrics (AAP) recommend against the practice of storing cord blood in private banks as “biological insurance” for use in unforeseen cases of disease down the road.
There are also concerns about the standards of care employed by some private banks. Research has suggested that public cord blood may be of a higher quality than privately stored blood because public banks – overseen by the FDA – are subject to more stringent regulatory oversight.
When cord blood banking makes sense
Cord-blood banking is broadly recommended for conditions that can be addressed by a stem cell transplant in the present day. In these cases – such as when a full sibling has a medical condition such as a genetic disorder or a cancer that could be treated with a transplant – the ACOG and AAP encourage the use of “directed” cord blood banking.
At present, cord blood transplants may be used to treat a variety of conditions including:
- Blood disorders, such as leukemia and lymphoma and certain types of anemia
- Other cancers, including neuroblastoma
- Immune deficiencies, such as severe combined immune deficiency
- Genetic metabolic disorders, including Hurler syndrome and Hunter syndrome
It’s estimated that, as of 2013, more than 30,000 stem cell transplants using cord blood had been performed worldwide in children and adults, and the number is growing as the technology and applications advance.
While cord blood banking has a relatively limited scope right now, experts anticipate that it could have broader uses in the future. Although no breakthroughs in therapy have yet been realized, research is under way for the use of cord blood transplants in a range of conditions including Alzheimer’s disease, diabetes, cerebral palsy, autism, lupus, and Tay-Sachs disease.
“Technology goes through cycles, and every 10 years or so you tend to see huge breakthroughs,” Letham adds. “Twenty years from now, while these stem cells sit in storage, we may have a range of new applications for them, and that’s very exciting.”