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Elective caesarean: does delay in cord clamping for 30 s ensure sufficient iron stores at 4 months of age? A historical cohort control study
  1. Ola Andersson1,2,
  2. Lena Hellström-Westas1,
  3. Magnus Domellöf3
  1. 1Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
  2. 2Department of Research and Development, Region Halland, Sweden
  3. 3Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
  1. Correspondence to Dr Ola Andersson; olamedmac{at}


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.

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

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  • Twitter Follow Ola Andersson at @olamedmac

  • Contributors OA, LH-W and MD planned the study. OA was responsible for staff training, study management and data collection with support from LH-W and MD. OA, LH-W and MD analysed the data. OA drafted the manuscript. All authors revised the manuscript and accepted the final version. OA is the guarantor.

  • Funding The study was supported by grants from the Regional Scientific Council of Halland; the Southern Healthcare Region's common funds for development and research; and H.R.H. Crown Princess Lovisa's Society for Childcare.

  • Disclaimer The funders had no involvement in study design; the collection, analysis and interpretation of data; neither in the writing of the report or in the decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Ethics approval The original study was approved by the Regional Ethical Review Board at Lund University (2008/41), and the new cohort including elective CS was approved by an amendment (2009/344).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.