Prospective parents face an array of medical decisions before their baby is born, but now families are facing a new question: “Should they shell out $1,500 or more to store blood taken from their baby’s umbilical cord and placenta during delivery?”
The Washington Post has a nice story on this question: They say, “Since the 90s, “more than two dozen private, for-profit cord-blood banks have sprung up in the United States, offering to store cord blood that could ‘prove valuable’ because its stem cells could help ease transplants or ‘treat blood cancers’.”
But, according to the Post, “a study published last month in the journal Pediatrics, which surveyed 93 pediatric transplant physicians in the United States and Canada,” found no benefits in the practice.
Yet, Frances Verter, of the “Parent’s Guide to Cord Blood Foundation, called the Pediatrics study ‘ridiculous,'” because according to Verter, “physician opposition to private cord-blood banking reflects an ‘entrenched mind-set’ that could prove harmful to patients.”
Frances, with all due respect, I say, “Baloney!” And, so do the experts. And, so does this new study.
Prospective parents face an array of medical decisions before their baby is born: Which physician practice to use for the baby? If it’s a boy, to circumcise, or not? What about prenatal testing to screen for possible genetic disorders?
In recent years a new question has arisen: Should they shell out $1,500 or more to store blood taken from their baby’s umbilical cord and placenta during delivery for possible personal use in the future?
Why would parents do this? Because, the sales pitch goes, cord blood contains stem cells that can be used in lifesaving transplants, often to treat blood cancers.
Since the mid-1990s more than two dozen private, for-profit cord-blood banks have sprung up in the United States, marketing this form of “just in case” insurance to new parents.
Through targeted mailings and brochures displayed in obstetricians’ and family physicians’ waiting rooms and hospitals, they seek to persuade new parents to pay for the collection and storage of cord blood that could prove valuable in treating a serious illness in the child or a close relative.
But, what many parents don’t know is that in some states a parallel network of public banks allows parents to donate cord blood (which is typically discarded at the hospital after the baby’s birth), for use free of charge by anyone who needs it, operating much as a conventional blood bank does. And, support for public cord-blood banking is, admittedly, widespread in the medical community.
So is private cord-blood banking a wise move for most parents?
Not according to this new study, published last month in the journal Pediatrics, which surveyed 93 pediatric transplant physicians in the United States and Canada.
Its results echo reservations about the practice expressed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (ACOG).
Last year ACOG published an opinion in which it called on its members to present balanced information about the pros and cons of the practice, to disclose potential conflicts of interest, and to tell patients it is not clear how long stored cord blood remains viable.
“Patients need to be aware that the chances are remote that the stem cells from their baby’s banked cord blood will be used to treat that same child—or another family member—in the future,” said Anthony R. Gregg, MD, chair of ACOG’s Committee on Genetics. ACOG’s Committee Opinion is a joint document produced by the Committee on Obstetric Practice and the Committee on Genetics.
Although ACOG takes no position for or against cord blood banking, it recommends that physicians disclose that there is no reliable estimate of a child’s likelihood of actually using his or her own saved cord blood later.
Some experts estimate this likelihood at 1 in 2,700, while others argue the rate is even lower. According to ACOG, “Physicians should also disclose to their patients that it is unknown how long cord blood can successfully be stored.”
Also, according to ACOG, “Pregnant women should be aware that stem cells from cord blood cannot currently be used to treat inborn errors of metabolism or other genetic diseases in the same individual from which they were collected because the cord blood would have the same genetic mutation.”
“Cord blood collected from a newborn that later develops childhood leukemia cannot be used to treat that leukemia for much the same reason,” said Dr. Gregg.
For many of the same reasons, the AAP supports public, and not private, cord blood banking.
The AAP tells doctors, “Cord blood donation should be discouraged when cord blood stored in a bank is to be directed for later personal or family use, because most conditions that might be helped by cord blood stem cells already exist in the infant’s cord blood (ie, premalignant changes in stem cells).”
The AAP says, “Physicians should be aware of the unsubstantiated claims of private cord blood banks made to future parents that promise to insure infants or family members against serious illnesses in the future by use of the stem cells contained in cord blood.“
As to public cord blood banking, the AAP advises: Cord blood donation should be encouraged when the cord blood is stored in a bank for public use. Parents should recognize that genetic (eg, chromosomal abnormalities) and infectious disease testing is performed on the cord blood and that if abnormalities are identified, they will be notified.
This new study just adds further support for the AAP and ACOG postions.
In the Pediatrics study, transplant specialists who collectively have performed thousands of stem cell transplants for childhood leukemia and other illnesses report that only 50 involved privately banked blood.
Forty-one cases involved blood used to treat a family member, often a sibling; in 36 of those cases the need for a transplant was known before the cord blood was collected.
Only nine cases involved giving cord blood back to the donor, a practice known as autologous transplantation and the chief selling point for private cord-blood banking.
“In the absence of a family member known to be a candidate for stem cell transplant, the chances that privately banked cord blood will be used are quite small,” said Steven Joffe, co-author of the study and a transplant physician at Boston’s Dana-Farber Cancer Institute.
While stem cell transplants using infusions of cord blood can be lifesaving, they have limitations. In some cases cord blood cannot be used, because of the high probability that it contains malignant or otherwise damaged cells.
Montgomery County resident Frances Verter, founder of the Parent’s Guide to Cord Blood Foundation, called the Pediatrics study “ridiculous” and said it was a disservice to parents trying to make an important decision.
Verter, whose oldest daughter died of leukemia in 1997 at age 4, said she privately banked the cord blood of her two younger daughters to avoid searching internationally in case one of them needed a future transplant. The blood remains in storage.
In Verter’s view, physician opposition to private cord-blood banking reflects an “entrenched mind-set” that could prove harmful to patients.
She says, “Suppose in a few years there are a lot of uses for cord blood?”
I say, “Suppose in a few years there are NO uses for the privately stored cord blood?”
In these tough economic times, the proof is that the private storage of cord blood is an unnecessary expense for the vast majority of couples who have a baby.
The AAP has a FAQ webpage that can give you more trustworthy information on this issue.