It is now possible to take blood at birth in the hope of creating cells later to combat future illness but is it worth it? Claire O'Connell reports
When a baby is due, parents face many choices. Names, religion, schools and types of car seat rank among them. But increasingly, parents in Ireland are also considering whether to take a blood sample from the newborn that may save lives later on.
Blood from a baby's umbilical cord, the link in the womb to its mother, is a rich source of stem cells, which are master cells that have the capacity to give rise to other cell types. Parents are now paying commercial companies thousands of euros to store cord blood for several years in case these stem cells could later help treat medical conditions in their family.
Doctors use cord blood to treat rare forms of leukaemia and other blood disorders and it looks like we will be using stem cells more widely to treat other diseases in the future. But experts debate whether it is worth taking out the insurance of storing a child's cord blood now in case it might be useful in coming decades, and some maternity hospitals are choosing not to support cord blood collection unless there is a directed medical need.
One of the most high-profile uses of cord blood today is in childhood leukaemia. While most cases can be cured by chemotherapy alone, some children need a bone marrow transplant where their existing marrow is killed off and replaced with healthy donated marrow or cord blood, both of which contain stem cells, says Dr Aengus O'Marcaigh, a consultant paediatric haematologist at Our Lady's Hospital for Sick Children in Crumlin.
If a sample of cord blood from a sibling is available and provides a good match for transplant, it can be transfused into the sick child whose bone marrow has been destroyed. The stem cells from the cord blood can give rise to a whole new blood system within a few weeks, says O'Marcaigh.
But cord blood is rarely used to treat the disease. "Only about 20 per cent of children with leukaemia would need a transplant," says O'Marcaigh. "And for every cord that we collect we know that three out of four are not going to be a match."
He believes that if a child has a high-risk leukaemia and the mother is pregnant, then collecting a cord blood sample from the baby is justified, particularly as it is a minimally invasive procedure. But he does not advocate banking samples where there is no apparent need. For children with no risk factors I really don't think it is indicated," says O'Marcaigh. Indeed he chose not to bank his own children's cord blood, reckoning instead that it will become easier to obtain stem cells from other tissues in future. "I would be hopeful that if any of my kids need [ stem cell] therapy, the technology would be there to extract the stem cells from the peripheral blood or the bone marrow," he says.
Prof Frank Barry, scientific director of the Regenerative Medicine Centre (Remedi) at the National University of Galway, notes that by choosing to bank cord blood parents are investing in a future possibility rather than a reality. But he is optimistic about the future therapeutic benefits and he lists diseases such as multiple sclerosis, heart disease and arthritis where early experiments are looking at potential stem cell treatments. "If I were a new parent again I would certainly have my kid's umbilical cord collected," he says. "If it offers a small element of hope it's worth doing."
And increasing numbers of Irish parents want to put their money down on that hope. Medicare, a company that facilitates cord blood collection and storage, facilitated about 150 collections last year, according to nurse specialist and regional manager Grania Howard. She believes that within five years up to 7 per cent of babies delivered in Ireland will be having cord blood banked, which she likens to taking out an insurance policy.
"It does look like in the next five years stem cells will be used for much more than they are now and that's a justifiable reason for collecting them," says Howard, who recently banked cord blood from her own son because of a family history of heart conditions. "I have absolutely no doubt that they will use stem cells in the future to treat heart disease," she says.
Medicare provides parents with a simple kit for collecting cord blood just after birth. They then ship the sample to be stored frozen for up to 20 years at an overseas facility that complies with the most up-to-date EU directives on quality control, says Howard.
Parents pay €1,850 for the service and Howard says that most of their clients are private maternity patients. "We would say to people if you can afford to do it then do it, if you can't then don't go getting loans or feeling under pressure," she says. Parents should also discuss it with the hospital before they buy the kit, says Howard, who says that hospitals are not liable if for any reason the blood cannot be collected.
Indeed hospitals have the discretion to say no from the outset. For example, a joint memo last August from the masters of the Coombe, Rotunda and National Maternity Hospitals stated that "there is insufficient scientific evidence to support the practice of taking routine cord blood for stem cell retrieval". In addition, the hospitals have concerns about the ethics of how the stem cells may be used after the storage period, according to Anne Rath, a clinical midwife manager at the National Maternity Hospital at Holles Street. "There's no definite evidence as to how well they will be used, and we have no idea in the future what way they will be used," she says.
This means that the three hospitals, which combine to deliver around 20,000 babies each year, do not support maternal requests to collect cord blood. However, they will allow the Blood Transfusion Service Board to collect a sample if a paediatrician has requested it for a sibling who may benefit, says Rath.
Some hospitals are more accommodating of parents who choose to collect cord blood where there is no current medical reason. One is Mount Carmel, a private maternity unit in south Dublin. "It is up to the individual consultant but the hospital is supportive of our decision with the patient," says consultant obstetrician Dr Gerry Rafferty. But again the onus is on the parents.