Review Finds Delayed Cord Clamping After Birth Better For Baby's Health

Dr. Enrique Jacome

At most hospitals it is common practice to clamp the baby's umbilical cord less than a minute after birth. But a recent review of published studies suggests delaying cord clamping results in healthier blood and iron levels in babies, and this benefit outweighs the slightly higher risk of developing jaundice.

The reviewers arrived at this conclusion after analyzing data on nearly 4,000 women and their babies. They report their findings online in a July 11th issue of the Cochrane Database of Systematic Reviews.

One of the authors, Philippa Middleton of the Australian Research Centre for Health of Women and Babies at the University of Adelaide, says in a statement: 

"In light of growing evidence that delayed cord clamping increases early haemoglobin concentrations and iron stores in infants, a more liberal approach to delaying clamping of the umbilical cord in healthy babies appears to be warranted."

At most hospitals, the standard practice is to clamp the umbilical cord within a minute of the baby being born.

If cord clamping is delayed, the risk that the baby will develop jaundice rises. Newborns with jaundice are treated with light therapy.

However, stopping the blood from the placenta reaching the baby before the final few pulses stop, means there is a chance the baby will not receive enough blood from the mother and will have lower iron levels.

Middleton says they did find that clamping the cord later was linked to higher numbers of babies needing treatment for jaundice, however, she urges that:

"The benefits of delayed cord clamping need to be weighed against the small additional risk of jaundice in newborns. Later cord clamping to increase iron stores might be particularly beneficial in settings where severe anaemia is common"

The researchers reviewed 15 trials comparing early and late cord clamping covering a total of 3,911 women and their infants.

They examined results for mothers and babies separately, using haemoglobin measures as indicators of healthy blood and iron levels.

Although another reason sometimes given for early cord clamping is that it reduces the mother's risk of bleeding after birth, the reviewers found no evidence of this.

Benefits of delayed cord clamping did not come with any increased risks

Delayed cord clamping did not change the mother's risk of haemorrhaging, losing blood or having reduced haemoglobin levels, they note.

But delaying cord clamping did make a difference to the health of the babies. Between one and two days after birth, their haemoglobin levels were higher; between three and six months after birth, they were less likely to be deficient in iron.

The reviewers also found that delayed cord clamping was linked to higher birth weight and made no difference to deaths in newborns.

They also found delayed cord clamping appears to have no effect on longer-term brain development, although only one of the trials examined this.

The reviewers conclude their findings suggest we need to adopt a "more liberal approach" to delaying cord clamping which is likely to benefit babies, "as long as access to treatment for jaundice requiring phototherapy is available".

The World Health Organization recommends cord clamping between one and three minutes after birth.

This review only included babies born full term. However, another review published in the same journal in 2012 found that delayed cord clamping also benefits preterm babies. 

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Breast Really Is Best: Unraveling The Scientific Basis Of This Infant Feeding Axiom

Dr. Enrique Jacome

Scientists are making strides toward unraveling the surprisingly complex chemistry underpinning that axiom of infant feeding "breast is best," according to an article in the current edition of Chemical & Engineering News. C&EN is the weekly newsmagazine of the American Chemical Society, the world's largest scientific society.

Jyllian Kemsley, C&EN senior editor, points out that their findings reveal many intriguing and sometimes counterintuitive ways in which sugars, proteins and fat in milk interact with microbes in infants' intestines to nourish babies and protect their health. For instance, scientists have discovered that breast milk contains oligosaccharides, complex sugars that babies can't even digest. It turns out these oligosaccharides, rather than providing nutritional value directly to infants, actually confers protection. They feed beneficial intestinal bacteria that seem to crowd out harmful E. coli strains that might otherwise thrive.

This multifaceted research includes an approach termed "diaper diagnostics," in which scientists glean information from infants' urine and feces. The breast milk projects are important for figuring out how best to nourish infants who aren't breastfed, especially premature babies, 10 percent of whom contract an intestinal disease that can be life-threatening. Based on findings so far, one research team is developing probiotics and testing them in neonatal units to see if they help guard against harmful infections.

The article makes clear that a more complete understanding of breast milk content and its effect on gut bacteria could help give more babies a healthier start.

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Study Shows Pelvic Organ Prolapse An Increased Risk With Vaginal Delivery

Dr. Enrique Jacome

Women who give birth vaginally are at increased risk of developing pelvic organ prolapse during the year after delivery, according to a study of Chinese women by researchers at Yale School of Medicine and Wenzhou Third People's Hospital. 

Published online in the British Journal of Obstetrics and Gynaecology, the results show that factors unique to labor and delivery made the pelvic floor relax and not recover its former support during the year after birth. These factors were not present in women who delivered via cesarean section. 

"The choice between vaginal birth and c-section is a complex one, and our results are not meant to promote one over the other," said Marsha K. Guess, M.D., assistant professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine. "Our data will be useful to women and their obstetric providers as they weigh childbirth options." 

Pelvic organ prolapse is a common condition among women who have given birth vaginally. Hormonal changes, increased pressure, and the baby's passage through the birth canal can damage connective tissue, muscles, nerves, and blood vessels. The vagina and the surrounding organs relax, lose their support, and fall from their normal positions, leading to a host of complications such as urinary incontinence and bowel control. It is thought that some women are genetically predisposed to having an abnormal repair process after delivery, which may also contribute to pelvic organ prolapse. 

In this prospective observational study, Guess, corresponding author Yi Chen, and colleagues, compared changes in pelvic organ prolapse during late pregnancy with changes at three different points in time within one year after delivery. Between April and May 2009, they evaluated 110 women at the obstetrics clinic in Wenzhou Third People's Hospital in Wenzhou, Zhejiang, China. These women were in their 36th-38th week of pregnancy and were planning to undergo an elective c-section or vaginal delivery. 

They found that many women develop moderate prolapse in late pregnancy; however, women who underwent vaginal delivery or c-section after laboring were less likely to recover from pelvic organ prolapse at six weeks, six months, and one year postpartum, compared to those who delivered after an elective c-section with no labor. 

"Our study is among the few that provide information about short- and long-term effects of labor and route of delivery on pelvic floor support to determine if and when recovery of pelvic floor support structures occurs over long durations of time," said Guess. "More research should be done to better identify women at greatest risk for, or predisposed to developing, long-term pelvic floor consequences." 

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Research Shows Potential For Novel Treatments Of Uterine Fibroids

Dr. Enrique Jacome

Uterine leiomyomata, or fibroids, are benign tumours that nevertheless affect the health of millions of women. They may cause, for instance, pain, bleeding and infertility. Fibroids are also the most common reason for a hysterectomy; for example, some 8,000 hysterectomies are made in Finland each year. 

Scientists at the Academy of Finland's Centre of Excellence in Cancer Genetics Research have identified the molecular mechanisms underlying the onset of common leiomyomata. The results of their research were published in the top medical journal New England Journal of Medicine in early June. 

"These new findings are essential for the further development of pharmacological treatments for this type of tumour," says Academy Professor Lauri Aaltonen, who heads the Centre the Excellence based at the University of Helsinki. 

Aaltonen's team has demonstrated how the genome of benign uterine leiomyomata differs from normal uterine tissue. Very little was known about the aetiology of leiomyomata before the team's research. The team has previously identified a gene defect that explains more than half of these tumours. The present whole-genome sequencing proved that most of the rest of the tumours develop as a result of chromosome fragmentation and rearrangements. 

"Complex chromosomal rearrangements are a major cause of cellular changes that contribute to the onset of benign uterine leiomyomata," Aaltonen states. 

Similar changes resulting from chromosomal rearrangements are normally identified in malignant tumours. The results of Aaltonen's team suggest that the same mechanisms may also underlie the onset of non-cancerous tumours. 

"Our research also indicates what mechanisms may prevent benign tumours from becoming malignant," Aaltonen adds. 

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Plan B One-Step Fight Over, Now All Ages Can Get It

Dr. Enrique Jacome

The FDA has approved the morning after pill for women of any age as an over-the-counter medication and with no point-of-sale restrictions. Over-the-counter (OTC) means that no prescription is required.

The FDA said the approval is for "women of child bearing age potential", i.e. any female who can get pregnant.

The approval of Plan B One-Step (levonorgestrel) as an OTC medication for all women of all ages complies with the April 5th, 2013 order by the US District Court of New York.

What is Plan B One-Step?

Plan B One-Step (levonorgestrel), also known as the morning after pill is an emergency contraceptive a female takes to reduce her chances of pregnancy after either unprotected sexual intercourse or suspected contraceptive failure. An example of a (suspected) contractive failure could be a condom that leaked.

Experts say that the term "morning-after pill" is a misnomer, because the pill is most effective when used shortly after sex.

Plan B One-Step is now available OTC for all women of childbearing age potential

According to Teva Women's Health, the makers of Plan B One-Step, the drug can be used within 72 hours after sex, but ads that the sooner it is taken, the more effective it is.

Plan B One-Step contains levonorgestrel, the same ingredient that is used in many birth control pills and works similarly by stopping ovulation (stops the release of an egg from the ovary). It has a higher level of levonorgestrel than other contraceptive pills that doctors have been prescribing for decades.

Teva Women's health emphasizes that Plan B One-Step:

• Is not an abortion pill (an RU-486)
• Is ineffective if the woman is already pregnant
• Should not affect/terminate an existing pregnancy
• Is not intended as a regular form of birth control
• Will not protect the woman from HIV or other STDs (sexually transmitted diseases)

The FDA says that it notified a US District Court judge in New York that it intended to comply with the court's order. The Agency asked Teva Women's Health to submit a supplemental application for approval of Plan One-Step B to be made available OTC with no restrictions. The FDA says it has now fulfilled its commitment to the court.

Janet Woodcock, M.D., director of the FDA's Center for Drug Evaluation and Research, said:

"Over-the-counter access to emergency contraceptive products has the potential to further decrease the rate of unintended pregnancies in the United States."


In July 2009, Plan B One-Step was approved by the FDA as an OTC medication for females aged at least 17 years, and as a prescription-only product for younger patients.

The FDA later approved Plan B One-Step as an OTC product for females aged 15+ yearsearlier this year.

In an online communiqué yesterday, the FDA wrote "With this approval, the product is now available without a prescription for use by all women of reproductive potential."

The FDA reminded young women who are sexually active and do not plan or intend to become pregnant to see a health care provider for routine checkups. The health care provider should advise them about, and test them for STDs, as well as discuss effective methods of birth control.

The following side effects are associated with Plan B One-Step usage:

• nausea
• vomiting
• stomach ache
• headache
• dizziness
• breast tenderness

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Long-Term Stress Suffered By Women Often Will Manifest In Physical Symptoms

Dr. Enrique Jacome

In four out of ten cases, long-term stresssuffered by women leads to some form of physical complaint. This is shown by a study of 1,500 women carried out at the Sahlgrenska Academy, University of Gothenburg, Sweden. 

Within the Population Study of Women in Gothenburg, researchers at the University of Gothenburg's Sahlgrenska Academy have followed around 1,500 women since the late 1960s. 

The latest study within the project, which focuses primarily on stress linked to psychosomatic symptoms, showed that one in five middle-aged women had experienced constant or frequent stress during the last five years. The experience of stress was highest within the 40 to 60 age range, and those women who were stressed were more often single and/or smokers. 

Among those women who reported stress, 40 percent had psychosomatic symptoms in the form of aches and pain in their muscles and joints, 28 percent suffered from headaches ormigraines, and the same proportion reported gastrointestinal complaints. 

"Even when the results have been adjusted for smoking, BMI and physical activity, we can see a clear link between perceived stress and an increased incidence of psychosomatic symptoms," says Dominique Hange, researcher at the Sahlgrenska Academy, University of Gothenburg. 

Of those women who experienced long-term stress but who did not report any stress-related problems when the study began in 1968-69, 27 percent had new symptoms in the form of muscular and joint pain when they were followed up 12 years later, and around 15 percent experienced new complaints in the form of headaches and/or gastrointestinal problems. 

"Since 1968, women's lifestyles have changed in many ways," continues Dominique Hange. "For example, many more women now work outside the home. Naturally, these changes can affect the experience of stress. But although we've used exactly the same question ever since 1968, we can't take it for granted that the term 'stress' has exactly the same meaning today. It might also be more socially accepted today to acknowledge one's experience of stress." 

The researchers have been able to follow all 1,500 of the women who took part at the beginning of the study in 1968 up until today, including information about cause of death. The studies do not show any clear signs that stress leads to an increased risk of an early death. 

"The most important conclusion is that single women, women who do not work outside the home and women who smoke are particularly vulnerable to stress. Here, we see a greater need for preventive measures from society." 

The next stage will involve the researchers evaluating which methods can be used within healthcare, particularly within primary care, in order to help the individual to deal with stress-triggered complaints and illnesses, and to study how the individual and society can reduce the risk of exposure to stress at work. 

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Infant Brains Benefit From Breastfeeding

Dr. Enrique Jacome

A new study by researchers from Brown University finds more evidence that breastfeeding is good for babies' brains. 

The study made use of specialized, baby-friendly magnetic resonance imaging (MRI) to look at the brain growth in a sample of children under the age of 4. The research found that by age 2, babies who had been breastfed exclusively for at least three months had enhanced development in key parts of the brain compared to children who were fed formula exclusively or who were fed a combination of formula and breastmilk. The extra growth was most pronounced in parts of the brain associated with language, emotional function, and cognition, the research showed. 

This isn't the first study to suggest that breastfeeding aids babies' brain development. Behavioral studies have previously associated breastfeeding with better cognitive outcomes in older adolescents and adults. But this is the first imaging study that looked for differences associated with breastfeeding in the brains of very young and healthy children, said Sean Deoni, assistant professor of engineering at Brown and the study's lead author. 

"We wanted to see how early these changes in brain development actually occur," Deoni said. "We show that they're there almost right off the bat." 

The findings are in press in the journal NeuroImage and available now online. 

Deoni leads Brown's Advanced Baby Imaging Lab. He and his colleagues use quiet MRI machines that image babies' brains as they sleep. The MRI technique Deoni has developed looks at the microstructure of the brain's white matter, the tissue that contains long nerve fibers and helps different parts of the brain communicate with each other. Specifically, the technique looks for amounts of myelin, the fatty material that insulates nerve fibers and speeds electrical signals as they zip around the brain. 

Deoni and his team looked at 133 babies ranging in ages from 10 months to four years. All of the babies had normal gestation times, and all came from families with similar socioeconomic statuses. The researchers split the babies into three groups: those whose mothers reported they exclusively breastfed for at least three months, those fed a combination of breastmilk and formula, and those fed formula alone. The researchers compared the older kids to the younger kids to establish growth trajectories in white matter for each group. 

The study showed that the exclusively breastfed group had the fastest growth in myelinated white matter of the three groups, with the increase in white matter volume becoming substantial by age 2. The group fed both breastmilk and formula had more growth than the exclusively formula-fed group, but less than the breastmilk-only group. 

"We're finding the difference [in white matter growth] is on the order of 20 to 30 percent, comparing the breastfed and the non-breastfed kids," said Deoni. "I think it's astounding that you could have that much difference so early." 

Deoni and his team then backed up their imaging data with a set of basic cognitive tests on the older children. Those tests found increased language performance, visual reception, and motor control performance in the breastfed group. 

The study also looked at the effects of the duration of breastfeeding. The researchers compared babies who were breastfed for more than a year with those breastfed less than a year, and found significantly enhanced brain growth in the babies who were breastfed longer - especially in areas of the brain dealing with motor function. 

Deoni says the findings add to a substantial body of research that finds positive associations between breastfeeding and children's brain health. 

"I think I would argue that combined with all the other evidence, it seems like breastfeeding is absolutely beneficial," he said. 

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