Should you consider umbilical cord blood banking?

There are so many issues to consider when you’re pregnant: Do you plan to breastfeed or bottle-feed? Are you thinking of having an epidural or trying for a medication-free birth? Another question your OBGYN may bring up at your prenatal exams: Do you want to save your newborn’s umbilical cord blood? Many new parents are saying yes: In fact, cord blook banking has grown to a nearly $9 billion industry, according to a 2022 report by The Business Research Company.

Nikola A. Letham, DO, an OBGYN with Virginia Women’s Health at LewisGale Hospital Montgomery in Blacksburg, Virginia, has guided numerous patients through the process of cord blood banking. Here, he discusses the ins and outs of the procedure so you can make the decision that’s right for you.

What is cord blood and why is it valuable?

The blood that remains in the umbilical cord and placenta after delivery is a source of cells that are known as hematopoietic stem cells. Because of their regenerative power, these cells have the potential to develop into a variety of tissues in the body, and they can be used to treat diseases including cancer as well as blood and immune disorders. They also have the benefit of being more versatile and better tolerated in patients than transplants of conventional bone marrow.

While the cord blood, umbilical cord, and placenta are typically discarded after a delivery, you can choose to preserve, or bank, the blood in hopes it may be used to treat diseases in the future.

How is cord blood banked?

If you decide to bank your newborn’s cord blood, sometime in the third trimester, you’ll order a special kit that contains everything your healthcare provider (HCP) will need to preserve the sample.

“When the patient comes to the hospital, along with bringing the kit, they need to make the staff aware that it’s their intention to do cord blood banking,” says Dr. Letham. A special blood sample will also need to be taken from the person giving birth.

Immediately after birth, your HCP will clamp the umbilical cord, clean it, and draw out 40 milliliters or more of blood. The blood will drain through a needle into a bag.

“Some of the cord-blood-banking companies also allow for a segment of the umbilical cord to be collected as an additional source of stem cells,” says Letham.

The blood and sample (if taken) are then preserved in the kit, and the cord blood bank will arrange to have the kit shipped back to their facility for storing.

If you elect to donate your baby’s cord blood to a public bank (more on that below), you should be sure to alert the bank and your HCP before your arrival at the hospital. During your hospital stay, the public bank—working with your HCP—will usually take care of shipping your sample.

Blood and tissue samples may be drawn either before or after the placenta is delivered. In either case, your health care team should ensure the procedure does not interfere with delivery of the baby. Cord blood can be extracted regardless of whether you’ve had a vaginal birth or a cesarean section.

What types of cord blood banking are there?

There are two main ways to store cord blood: public and private banking.

Public banks collect and store cord blood for use by anyone with a medical condition that may benefit from a blood stem cell transplant. Some—though not all—hospitals throughout the country are certified to participate in public banking. If you would like to donate cord blood to a public bank, you should check beforehand whether your hospital and HCP participate in a cord banking program.

There are more than two dozen public cord blood banks in operation in the United States as of 2022. Some states require HCPs to inform their patients about the public cord blood banking options available to them, while others do not. Major organizations, like the American Academy of Pediatrics (AAP), recommend the use of public cord blood banking.

When you donate cord blood or samples to a public bank, it becomes anonymous and there is no way to trace the blood back to you or your child.

You will not have to pay any fees to donate cord blood to a public bank, but the flip side of that is that you are not guaranteed access to those stem cells in the future if you, your child, or another member of your family should need them, Letham explains. “They’re in the public domain.”

But that does mean that the sample you donate can be used to treat someone else with a life-threatening disease or may be used in research studies that could help gain insight into saving lives.

Private cord blood banks, on the other hand, are for-profit companies that enable you to save a portion of your newborn’s cord blood for the exclusive use of your child, other family members, or anyone else to whom you wish to donate the blood in the future.

This process comes at a price. The upfront costs to store cord blood range between $300 and $2,300, plus up to $1,300 more for storage of placental tissue. After that initial cost, you could be billed between $150 and $400 annually for storage. These costs are not typically covered by insurance.

Can anyone bank cord blood?

Generally speaking, any family that wishes to bank their baby’s cord blood for private use may do so, as long as they can pay for it. Public banks, meanwhile, screen samples to ensure they will be safe for use by others.

If you choose to donate your newborn’s cord blood to a public bank, you will most likely be asked to fill out a questionnaire that screens donors for certain infectious, inherited, and genetic diseases, as well as conditions that could be transmitted by blood. While in the hospital, the blood of the person giving birth is also tested for diseases such as hepatitis B and C, HIV, malaria, and syphilis.

Should I store my baby’s cord blood?

Banking your baby’s cord blood is entirely up to you. As you weigh the decision, the first issue to contemplate is public versus private banking.

“If your hospital has a program and your doctors participate, there's probably no downside to doing public cord banking,” says Letham. “You can think of it as doing a public service, potentially helping somebody else with really no effort on your behalf.”

Should you ever be on the other side of the equation—in need of a cord blood donation from a public bank—the National Marrow Donor Program’s Be the Match service can help you find a match.

Important considerations for private banking

It’s important to understand that there is no guarantee that using a private bank to store your child’s cord blood to treat potential future diseases will work. The stored cells may have the same issues that contributed to the illness in the first place. For example, if your child should develop leukemia later in life, their stored cord blood may already contain pre-cancerous cells.

You should also keep in mind that the odds of using a stored cord blood sample for a member of your own family in the future are minuscule, estimated to be less than 4/100ths of 1 percent, or about 1 in 2,700.

To put the numbers into perspective, there are an estimated 8 million cord blood units stored in private cord blood banks, and an estimated 800,000 in public banks, but cord blood stem cells from public banks are used at a rate 30 times higher than those stored in private banks.

For these reasons—and because of the significant costs—the American College of Obstetricians and Gynecologists and the AAP do not recommend storing cord blood in private banks as biological “insurance” in case your child or a family member develops a disease down the road.

Research has also raised concerns about how well private banks are able to preserve the blood in their care. Public banks, on the other hand, are overseen by the U.S. Food and Drug Administration and are subject to more stringent regulatory oversight; studies have suggested that blood stored in these facilities may retain a higher quality.

When cord blood banking makes sense

There is one type of situation when cord blood banking for a family member is encouraged and can be lifesaving right away. This is called direct banking, and it occurs when an older sibling has a medical condition such as a genetic disorder or cancer that could be treated immediately with a stem cell transplant with the cord blood from a baby who is a full sibling. These directed banks are typically free of charge for families in need. ACOG and AAP both encourage this use of blood banking.

• At present, cord blood transplants may be used to treat a variety of conditions, including: Blood disorders, such as leukemia and lymphoma and certain types of anemia
• Other cancers, including neuroblastoma
• Immune deficiencies, such as severe combined immune deficiency
• Genetic metabolic disorders, including Hurler syndrome and Hunter syndrome

According to the U.S. Health Resources and Services Administration (HRSA), about 20,000 stem cell transplants occur each year, totaling more than 110,000 since 2016. That number continues to grow as the technology and applications advance.

Future promise

While cord blood banking currently has a limited scope, experts anticipate that it will have far broader uses in the future. Research is currently under way for the use of cord blood transplants in Alzheimer’s disease, diabetes, cerebral palsy, autism, lupus, and Tay-Sachs disease, among other conditions.

“Technology goes through cycles, and every 10 years or so you tend to see huge breakthroughs,” Letham adds. “Twenty years from now, while these stem cells sit in storage, we may have a range of new applications for them, and that’s very exciting.”