Immediate clamping of umbilical cord after birth associated with lower fine-motor and social skills at age 4, particularly in boys
Swedish researchers have associated delayed clamping of a newborn's umbilical cord with higher social and fine-motor skills in preschool boys. The findings, published today in JAMA Pediatrics, are of particular interest to those in the autism community who have suspected premature cord clamping as causing or contributing to the condition.
"This new study provides preliminary but interesting evidence that delaying cord clamping can improve aspects of child development, though it didn't look specifically at autism symptoms," comments developmental pediatrician Paul Wang, Autism Speaks head of medical research.
In previous research, the Swedish investigators linked early cord clamping (within 10 seconds of delivery) to iron deficiency in infants. Iron deficiency, in turn, has long been associated with poor behavioral, motor and intellectual development in children. Since then, the World Health Organization and other medical groups have recommended delayed cord clamping as a general practice. But obstetricians continue to vary in their practices.
More than a century ago, immediate cord clamping became common with the idea that it would reduce the risk of maternal bleeding and, more recently, that it would prevent infant jaundice (high bilirubin). But studies have since shown that it does neither.
"Delaying cord-clamping by just a few minutes gives infants a small transfusion of their own blood," Dr. Wang explains. "This is helpful because many infants, especially in the developing world, have low iron, and iron is critical for child development."
In their new investigation, the researchers followed up on the 600 infants from their earlier study when the children reached age 4. They were able to complete developmental assessments and parent questionnaires on 263. Of these, 141 had cord clamping delayed by 3 minutes or more after birth. The other 122 had cord clamping within 10 seconds of delivery.
Overall, the preschoolers in the delayed-clamping group had higher scores on several tests of fine-motor development as well as parent-reported social and personal-care skills. However, when the researchers looked separately at boys versus girls, they found clear differences only between the boys in the two groups. In addition, they found no broader differences in behavior or IQ among any of the groups.
They propose that larger differences might be seen among children at higher risk for iron deficiency than those in the relatively high-income families participating in their study.
"This study appears to be the first look at early versus delayed cord clamping and neurodevelopmental outcomes," says epidemiologist Michael Rosanoff, Autism Speaks' director for public health research. "While preliminary, these interesting findings warrant further investigation."
In an accompanying editorial, experts from the University of Rhode Island and Brighton and Sussex Medical School write:
"Awareness of the benefits [of delayed cord clamping] for all newborns continues to increase as more studies are published. While many physicians have incorporated delayed cord clamping into practice, there remains a hesitation to implement delayed cord clamping, particularly with full-term infants. …this hesitation should disappear."