e-Library of Evidence for Nutrition Actions (eLENA)


An online library of evidence-informed guidelines for nutrition interventions and single point of reference for the latest nutrition guidelines, recommendations and related information.

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Optimal timing of cord clamping for the prevention of iron deficiency anaemia in infants

Intervention | Last updated: 9 June 2023

At the time of birth, an infant is still attached to the mother via the umbilical cord, which is part of the placenta. The infant is usually separated from the placenta by clamping the umbilical cord.

Early cord clamping is generally carried out in the first 60 seconds after birth, whereas later cord clamping is carried out more than one minute after the birth or when cord pulsation has ceased.

Delaying cord clamping allows blood flow between the placenta and neonate to continue, which may improve iron status in the infant for up to six months after birth. This may be particularly relevant for infants living in low-resource settings with reduced access to iron-rich foods.

WHO Recommendations

Delayed umbilical cord clamping (not earlier than 1 min after birth) is recommended for improved maternal and infant health and nutrition outcomes.

Evidence

Systematic reviews used to develop the guidelines

Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes

Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Cochrane Database of Systematic Reviews. 2012; Issue 8. Art. No.: CD003248.

Summary of this review Alternate Text

Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes

McDonald SJ, Middleton P, Dowswell T, Morris PS. Cochrane Database of Systematic Reviews. 2013; Issue 7. Art. No.: CD004074.

Summary of this review Alternate Text

Related Cochrane reviews

Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes.

Rabe H, Gyte GML, Díaz‐Rossello JL, Duley L. Cochrane Database of Systematic Reviews. 2019; Issue 9. Art. No.: CD003248.

Related systematic reviews

Late umbilical cord-clamping as an intervention for reducing iron deficiency anaemia in term infants in developing and industrialised countries: a systematic review

Van Rheenen P, Brabin BJ. Annals of Tropical Paediatrics. 2004; 24(1):3–16.

Timing of umbilical cord clamping in term and preterm deliveries and infant and maternal outcomes: a systematic review of randomized controlled trials

Mathew JL. Indian Pediatrics. 2011; 48:123–129.

Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials

Hutton EK, Hassan ES. The Journal of the American Medical Association. 2007; 297(11):1241-1252.

Cost-effectiveness Learn More Alternate Text

Relevant cost-effectiveness analyses have not yet been identified.

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

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