Overview

Cord blood banking is a complex and often confusing topic. Advertisements for cord blood banking are everywhere when you are pregnant. Is it really biological insurance that can protect your family or an unnecessary expense? Take a step away from the marketing claims and explore the evidence on cord blood banking so you can make an informed decision for your baby. Learn how cord blood stem cells are used, what conditions they can treat, and the differences between public and private cord blood banks. Hear about the research on the pros and cons of banking your baby’s cord blood, especially how it fits with delayed cord clamping. After extensive research and outreach to multiple cord blood banks, I’m sharing everything I’ve learned so you can confidently decide whether cord blood banking is the right choice for you and your baby.

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Cord Blood Banking

Cord blood banking collects blood from the umbilical cord immediately after birth and stores it for potential future medical use. Cord blood is rich in hematopoietic stem cells, which can develop into different types of blood cells, including red blood cells, white blood cells, and platelets.

The History of Cord Blood Transplants

The first clinically documented use of cord blood stem cells was in successfully treating a six-year-old boy afflicted by Fanconi anemia in 1988. Since then, cord blood has become increasingly recognized as a source of stem cells that could be used in stem cell therapy. There are about 80 health conditions that may be treated with cord blood. This includes many types of cancers, bone marrow failure syndromes, blood disorders, metabolic disorders, immunodeficiencies, and some other diseases like osteopetrosis. Note that these are not common conditions, and your baby has a very small chance of developing any of these.

Cord Blood Banks

There are two main types of cord blood banks, public and private.

Private Cord Blood Banks

Storing your baby’s cord blood at a private bank ensures it is available solely for your baby or family’s potential use. The cost for collection and storage varies depending on the company. In comparing costs for the top private cord blood banks, the initial fee for collection and the first year of storage ranged from about $600-$1,000 with annual storage fees of $150-$200. Companies also offer discounted plans for 18 years or lifetime storage and offer payment plans.

Public Cord Blood Banks

Public cord blood banks accept donations from anyone, discard donations that don’t meet their quality control standards, and use national registries to find recipients. Cord blood banked in a public program may not be accessible for future private use and does not give you priority if you or your child ever needs a transplant. Many public cord blood banks are programs funded by the National Heart, Lung, and Blood Institute, the National Marrow Donor Program, the American Red Cross, or academic programs based in not-for-profit organizations.

The benefit of donating to a public bank is that your baby’s cord blood could potentially be life-saving for someone else. Samples sent to a public bank are tested for chromosomal abnormalities and infectious diseases, and the bank will notify you if they identify abnormalities. Public banks generally do not charge any fees.

Regulation of Cord Blood Banks

In the United States, establishments that perform any manufacturing steps for cord blood must register with the FDA. Registered establishments are subject to FDA inspection to ensure compliance with regulations and ensure prevention of infectious disease transmission. Cord blood stored at public banks for potential future use by a patient unrelated to the donor is subject to additional requirements and regulations. Some states, like New York and California, have additional licensing requirements for cord blood banks. Both public and private cord blood banks are also eligible for voluntary accreditation with the American Association of Blood Banks (AABB) or the Foundation for the Accreditation of Cellular Therapy (FACT).

How Cord Blood Banking Works

While each cord blood bank may have slight variations in their process, the overall steps are similar across companies. If you choose to bank your baby’s cord blood privately, you first sign up with a bank and complete the necessary paperwork. The company will send you a collection kit, which you must bring to the hospital or birth center. After your baby is born and the umbilical cord is cut, the blood is collected from the portion of the cord that was attached to your baby. Once collected, you notify the cord blood bank, and a medical courier picks up the sample and transports it to the laboratory for processing.

The laboratory evaluates the sample for cell count, viability, blood type, and contamination and performs other tests, including for diseases. Once evaluation and testing are complete, a cryoprotectant is added to help the cells survive freezing. The sample is then gradually cooled and placed in a liquid nitrogen tank for long-term storage.

If you are interested in donating to a public bank, you must find out if the hospital where you plan to have your baby supports cord blood donations. You can view a list of participating hospitals here. If your hospital can support a donation, please talk to your doctor or midwife to plan accordingly.

Expanded Services

Cord blood banking has expanded in recent years to include cord tissue, placental cells, and genetic testing.

Cord Tissue Banking

Cord tissue is rich in mesenchymal stem cells. These cells can differentiate into various types of cells, including bone, cartilage, and fat cells. Therapies using mesenchymal cells are being researched for regenerative medicine applications, such as repairing tissues, bones, and nerves. To bank cord blood and tissue the initial cost ranges from $1,300-$1,800 with annual storage fees of $150-200.

Placental Banking

Some companies also offer placental banking, which stores blood and tissue from the placenta. The placenta contains hematopoietic stem cells found in cord blood, mesenchymal stem cells found in cord tissue, and trophoblast-derived stem cells. Trophoblast-derived stem cells are not yet widely used in clinical applications; their potential is being studied in stem cell therapy, maternal-fetal medicine, and regenerative treatments. To bank cord blood and tissue and placental tissue, the initial cost ranges from $1,700-$2,000 with annual storage fees around $400.

Additional Services

Many cord blood banks offer additional services beyond storage, such as genetic testing and genome sequencing. These services analyze your baby’s DNA to identify potential genetic conditions, inherited disorders, or predispositions to certain diseases. Genetic testing can screen for specific mutations linked to conditions like cystic fibrosis, sickle cell disease, or metabolic disorders. Genome sequencing provides a more comprehensive analysis of the entire genetic code. The costs of these additional tests range from $175-750.

It is important to understand that many health conditions are not determined by genetics alone and result from a complex interaction between genetic predisposition and environmental factors such as diet, lifestyle, stress, and exposure to toxins. Genetic testing has enormous potential for improving healthcare, but it is still a developing technology. While there is a short window to collect cord blood or tissues after birth, genetic testing could always be done at a later date.

Can Your Baby Actually Use Their Own Cord Blood?

While cord blood banking is often marketed as biological insurance, you cannot assume your baby can use their own cord blood. Often, children who develop an immunological disorder are unable to use their own cord blood for transplant because their blood also contains the same genetic defect. This is often true with leukemia, which is a cancer and the largest use of cord blood stem cells. The likelihood that a person will require a transfusion using their own cord blood is estimated to range from 1 in 400 to 1 in 200,000.

If you plan to store cord blood at a private bank for use within your family, matching rates vary based on the relationship. Siblings have a 39% chance of being matched for a cord blood transplant. A baby’s cord blood has about a 50% chance of being a partial match for parents or grandparents. This means there is at least a 50% chance that a patient will not match a related donor, in which case they would need to rely on a public cord blood bank.

Matching Donors

If someone requires a cord blood transplant matching a patient and a donor relies on human leukocyte antigen (HLA) typing. HLAs are proteins found on most cells in the body that help the immune system distinguish foreign cells. Cord blood transplants require less precise HLA matching (4 out of 6)than bone marrow or other blood stem cell transplants requiring a full match on six key antigens. This is because the cells in cord blood are less mature, making them less likely to trigger an immune response.

Ethnic background also plays a role, as people from the same heritage are more likely to find a compatible donor. ACOG encourages families of all ethnicities and races to consider the societal benefit of public umbilical cord blood donation to increase the availability of matched cord blood units for people of all backgrounds. The American Academy of Pediatrics also addresses this and recommends that specific efforts need to be made to recruit underserved ethnic minorities for cord blood donations to enlarge the public cord blood repositories and better serve these patient populations.

How Does Cord Blood Collection Align with Delayed Cord Clamping?

Blood continues to flow between the placenta and the baby for several minutes after birth. This process, known as placental transfusion, can transfer up to 20% of the baby’s total blood volume, which can have significant health benefits. Additionally, draining the remaining blood from the placenta may help it detach more easily from the uterus and potentially reduce maternal blood loss after birth.

At some point after birth, the baby’s umbilical cord is clamped with a plastic clamp near the belly button, which halts the blood flow. Once the cord is clamped, it is cut, detaching your baby from the placenta. Immediate cord clamping became standard practice in the 1960s, based on the belief that it could reduce the risk of postpartum hemorrhage. However, research has since disproven this, and there is now strong evidence supporting delayed cord clamping as beneficial for both mothers and newborns.

The World Health Organization recommends delayed cord clamping, performed 1–3 minutes for all births. With the exception of a medical emergency requiring the cord be cut immediately, delayed cord clamping applies to all births, both vaginal and cesarean deliveries, as well as for full-term and preterm infants. The American College of Obstetricians and Gynecologists recommends delaying cord clamping for at least 30–60 seconds. Check out this episode to learn more about delayed cord clamping.

Research on Delayed Clamping and Cord Blood Collection

The timing from birth until the umbilical cord is clamped determines the amount of blood transferred from the placenta to the newborn and the remaining blood that can be collected and banked. Studies in term infants have shown that a transfer of blood from the placenta by one minute is approximately 80 mL and reaches approximately 100 mL at 3 minutes.

Two measurements are used to determine a cord blood sample’s quality and potential effectiveness. One is total blood volume of at least 40 mL, and the other is total nucleated cells. A higher total nucleated cell count generally correlates with a greater number of stem cells. In public cord blood banking, units that do not meet the minimum threshold are often discarded, while private banks will store them regardless of viability.

A study evaluated the impact of delayed umbilical cord clamping on cord blood collection and found that delaying from 30 to 60 seconds has a small negative impact. However, delaying cord clamping more than 60 seconds significantly decreases both total nucleated cell count and volume. 38% to 46% of cord blood units collected after more than 60 seconds have a volume of less than 40 mL, which may not be enough for storage or transplantation. Another study found similar results, and close to 40 % of the collections in the late clamping group still met the high TNC banking threshold and were eligible for banking. However, this also means that 60% of the cord blood samples in the delayed clamping group did not collect enough cord blood.

Another issue is whether the amount of cord blood collected at birth could be enough to support a child as they grow older. If an adult needs a cord blood transplant, they will require a much larger sample to match their body size. Only 8–10% of cord blood units have an adequate volume for adult use. Public cord blood banks often combine multiple donations to prepare a treatment for a single patient since a single collection may not contain enough stem cells. At a private bank you only have access to cord blood you banked and cannot combine multiple samples if a larger volume is needed.

Compatibility of Cord Blood Banking and delayed Cord Clamping

Delaying umbilical cord clamping and cord blood banking are not mutually exclusive; you can potentially do both. However, there is a finite amount of blood in the placenta, and the longer you delay clamping the umbilical cord, the less cord blood is available for banking.I contacted five of the largest private cord blood banks to inquire about delaying clamping and cord blood banking. I wish I could say I received a consistent answer, but unfortunately, that was not the case. The common theme was that yes, you can delay cord clamping, but the longer the delay, the less cord blood will be collected for banking.

The Medical Community’s View on Cord Blood Banking

There is some controversy in the medical community about private for-profit cord blood banks and whether private banks’ physicians, employees, and consultants have potential conflicts of interest in recruiting patients because of their own financial gain.

American Academy of Pediatrics

The American Academy of Pediatrics previously stated that the cord blood stem cell collection program should not alter routine practice for the timing of umbilical cord clamping. Unfortunately, their updated guidelines on cord blood banking do not mention delayed cord clamping. The AAP advocates for cord blood banking in public cord blood banks. According to the AAP, on average, cord blood stored in private cord blood banks is underused, not subject to strict regulatory oversight, expensive for the family, and may be of lesser quality (in number and quality of stem cells) than stored in public cord blood banks. In contrast, cord blood donated to public banks is more commonly used and heavily regulated. Thus, the cost and value of the maintenance of private cord blood banks is not supported by the evidence for use at the present time.

American College of Obstetricians and Gynecologists

According to the American College of Obstetricians and Gynecologists, umbilical cord blood collection should not compromise obstetric or neonatal care or alter routine practice of delayed umbilical cord clamping with the rare exception of medical indications for directed donation. A variety of circumstances may arise during the process of labor and delivery that may preclude adequate collection. For example, patients should be aware that delayed umbilical cord clamping significantly decreases the volume and total nucleated cell counts of cord blood donations.

ACOG concurs with the recommendation of the AAP and states the routine collection and storage of umbilical cord blood with a private cord blood bank is not supported by the available evidence. Public umbilical cord blood banking is the recommended method of obtaining umbilical cord blood for use in transplantation, immune therapies, or other medically validated indications.

American Medical Association

The American Medical Association recommends physicians ensure that collection procedures do not interfere with standard delivery practices or the safety of a newborn or the mother. They also recommend physicians encourage women who wish to donate umbilical cord blood to donate to a public bank.

All the major health organizations recommend donating to a public rather than a private bank. However, they all make an exception when there is a family predisposition to a condition for which umbilical cord stem cells are therapeutically indicated or when there is knowledge of a family member with a medical condition who could potentially benefit from cord blood transplantation.

The Business of Private Cord Blood Banks

Private cord blood banking is a multi-billion-dollar industry. The cost of storing cord blood for 18 years typically ranges from $3,500 to $9,000, and the price can be even higher if families continue storage beyond adulthood. Given the high potential lifetime value of each customer, private cord blood banks invest heavily in advertising to attract new parents. Their marketing often includes emotional appeals, using heartfelt stories of families who credit cord blood with saving their child’s life and emphasizing themes of security, protection, and planning for a healthier future. These advertising strategies can make cord blood banking an emotional decision rather than a medical one.

Weighing the Pros and Cons

Deciding whether to bank your baby’s cord blood is a personal choice that depends on your family’s medical history, financial considerations, and your beliefs about the potential future use of stem cells. As more research is done, we may see additional applications of cord blood to treat more conditions. It is also important to weigh the potential benefits of delayed cord clamping since prioritizing a longer delay may limit the amount of blood available for collection. If you have a family history of conditions that could potentially be treated with cord blood, this may be an additional factor in deciding whether private banking is the right choice for your family.

Private banking ensures the sample is reserved for your family’s use, but the cost of collection and long-term storage can be significant, and the likelihood of needing it is low. Public cord blood banking offers the opportunity to contribute to life-saving treatments for others at no cost but does not guarantee future access to the donated sample. If you are considering public donation, check whether your hospital participates in a cord blood donation program, as not all facilities have the necessary resources to support it.

Talking to Your Doctor or Midwife

Your doctor or midwife can assist you in navigating hospital policies, collection procedures, and whether delayed cord clamping can still be incorporated into your birth plan. Discuss the timing with your care provider if you are considering both cord blood banking and delayed cord clamping. Ask about their experience with collecting cord blood after a delay and whether they believe an adequate sample can still be obtained after waiting one minute, three minutes, or however long you plan to delay clamping and cutting your baby’s cord. Regardless of your decision, having an open conversation with your doctor or midwife can help you understand your options and ensure that your birth plan aligns with your preferences.

Thank you to the amazing companies that have supported this episode.