Acceptance of cord stem cell banking among pregnant women attending outpatient department of tertiary care hospital of Delhi Singh A, Gnana Chellaiyan D V, Dixit S, Midha T, Garg P, Arumugam1 A, Singh N,

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Acceptance of cord stem cell banking among pregnant women attending outpatient department of tertiary care hospital of Delhi

Abhay Singh¹, D Vinoth Gnana Chellaiyan², Shivam Dixit³, Tanu Midha⁴, Pragati Garg⁵, Aarthy Arumugam1², Neetu Singh⁶
¹ Department of Community Medicine, AIIMS, Raebareli, Uttar Pradesh, India
² Department of Community Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chennai, Tamil Nadu, India
³ Department of Community Medicine, MGM Medical College, Indore, Madhya Pradesh, India
⁴ Department of Community Medicine, GMC, Kannauj, Uttar Pradesh, India
⁵ Department of Ophthalmology, AIIMS, Raebareli, Uttar Pradesh, India
⁶ Department of Physiology, Era Medical College and University, Lucknow, Uttar Pradesh, India

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Date of Submission	24-Feb-2022
Date of Decision	01-Apr-2022
Date of Acceptance	04-Apr-2022
Date of Web Publication	27-Oct-2022

Abstract

Introduction: Cord blood banking, an alien concept till a few years ago, in India, is becoming popular nowadays. Cord blood banking is the practice of preserving, for future use, fetal blood that remains in the umbilical cord at the time of birth. Advancement in medical research has established the use of cord blood-based stem cells in the treatment of more than 70 diseases. It has a success rate of 99.6%. Objectives: The objective of the study is to access the awareness, determine the acceptance, and evaluate the practice of “cord stem cell banking” among pregnant women visiting the antenatal care clinic at Safdarjung Hospital. Methodology: This hospital-based cross-sectional study was carried out among 400 pregnant females attending antenatal clinics in Safdarjung Hospital, New Delhi. Through systemic random sampling, every third pregnant female attending the antenatal clinic was approached for the study. A pretested semi-structured questionnaire was used to collect data from the participants, which had questions related to the sociodemographic profile of the participant and questions on awareness, acceptance, and practice of cord stem cell banking. The collected information was analyzed using SPSS software version 21.0. Qualitative variables will be expressed in proportions and quantitative variables in mean (standard deviation)/median (interquartile range). A Chi-square test was applied. Results: 228 (57%) study participants were 20–23 years old. Although only 104 (26%) study participants were illiterate, 348 (87%) women remained unemployed. Women who participated in the study had atleast one living child. It is found from the study that only 80 (20%) women were aware of cord stem cell banking and social media was found to be the major source of information for all the participants. 50% of the total participants and 52.9% of those who wanted to know more about it were willing to do cord stem cell preservation in a future pregnancy. When coming to practice, none of the study participants had done cord stem cell banking in previous pregnancy, nor were they willing to do it in the current pregnancy. Among the participants who are not willing to do cord stem cell banking, 80 (40%) women found the procedure expensive, 60 (30%) women did not believe in the benefits of the procedure, and the remaining 60 (30%) women felt it as culturally unacceptable. It is to be noted that women are willing to do cord stem cell banking in a future pregnancy if their doctor recommends it (P = 0.000) and those women who are aware are also willing to do cord stem cell banking in a future pregnancy (P = 0.00). Conclusion: Awareness, acceptance, and practice of cord stem cell banking are not up to the mark. It is to be noted that social media serves as the only platform for the participants to know about cord stem cell transplants. However, if doctors educate and motivate their patients about it, a drastic change can be seen. It is also to be noted that educating mothers even during the postpartum is never going to be a waste as it can guide them in future pregnancies.

Keywords: Acceptance, awareness, cord stem cell banking, hematopoietic stem cell transplant

How to cite this URL:
Singh A, Gnana Chellaiyan D V, Dixit S, Midha T, Garg P, Arumugam1 A, Singh N. Acceptance of cord stem cell banking among pregnant women attending outpatient department of tertiary care hospital of Delhi. J Appl Sci Clin Pract [Epub ahead of print] [cited 2023 Jun 11]. Available from: http://www.jascp.org/preprintarticle.asp?id=358983

Introduction

Transplantation of hematopoietic stem cells (HSCs) to reconstitute the hematopoietic system is one of the major advances in medicine and has evolved considerably in recent years.^[1] Bone marrow and peripheral blood act as sources of HSCs. Hematopoietic stem cell transplantation (HSCT) is being carried out for life-threatening malignant and nonmalignant diseases of the blood and immune systems.^[2] The usage of HSCT is low as two-third of the patients who require HSCT are not having suitable donor.^[3]

The situation is transformed with the introduction of umbilical cord stem cells. Cord blood is the blood that is left in the placenta and umbilical cord after a baby is born. After the umbilical cord is clamped and cut, the cord blood is put into a sterile container, mixed with a preservative, and frozen until needed. These are stored in the umbilical cord blood (UCB) bank.^[4] Since the first umbilical cord blood transplantation (UCBT) in France in 1988, the growth of UCB banking to support the burgeoning interest in UCBT has been considerable. Dr. Pablo Rubinstein established the first unrelated UCB Bank at the New York Blood Center, supported by a pilot grant from the National Heart, Lung, and Blood Institute in 1981.^[5] Since that time, more than 160 public UCB banks have been established around the world.^[5] There are private cord blood banks available globally, storing UCB units for a particular family for an yearly fee. Hybrid banks offer combined public and private UCB storage solutions.^[6]

HSCs from UCB have more advantages compared to the other sources. HSCs from UCB require less stringent HLA-matching criteria. In addition, since these cells can be cryopreserved, this provides an instant solution to patients in urgent need of transplantation. The safety and efficacy of UCB-HSCT have been widely studied and accepted for usage in both children and adults for a variety of indications. When compared to HSCT involving stem cells from other sources, UCB-HSCT has a lower risk of graft-versus-host-disease (GVHD), a common and often fatal complication of HSCT, as well as greater protection against disease relapse in various settings.^[6] The applicability of HSCT has also markedly expanded with the introduction of UCBT, particularly for racial and ethnic minorities.^[7]

UCB banking, an alien concept is now becoming popular in India. This requires knowledge and awareness among the public. This study aims to access the awareness, determine the acceptance, and evaluate the practice of UCB banking among antenatal care (ANC) patients whose consent is important for it.

Methodology

This descriptive cross-sectional study was carried out among pregnant females attending antenatal clinic in Safdarjung Hospital, New Delhi, for 3 months. Based on the study by Fernandez et al.,^[8] 70% of women reported poor knowledge about UCB banking. Considering it as the prevalence with 95% confidence interval, allowable error of 5%, and non-response rate as 25%, the sample size was obtained as 400. Ethics committee approval was obtained. Through systemic random sampling, every third pregnant female attending the antenatal clinic was approached for the study. After obtaining informed consent, a pretested semi-structured questionnaire was administered to each participant. It had questions related to the sociodemographic profile of the participants and questions related to accessing the awareness, acceptance, and practice of cord stem cell banking. The awareness part of the questionnaire was scored with 1 for the right answer and 0 for the wrong answer. Those who scored 2 and above were considered to be aware. The collected data were entered in Microsoft Excel and analyzed with the help of SPSS software version 21.0. Qualitative variables will be expressed in proportions and quantitative variables in mean (standard deviation [SD])/median (interquartile range). A Chi-square test was applied to find the predictors of adequate knowledge and healthy practice of Infection prevention and control measures among students.

Results

A total of 400 pregnant women took part in the study. Most of the females (228, 57%) were between 20 and 23 years. Women who participated in the study had atleast one living child. 104 (26%) of the participants were illiterate. Illiteracy was more common among women when compared to their husbands. 23% of the study participants attained a primary level of education. Middle school education was obtained only by 7%. Secondary and senior secondary education was acquired by 12% and 4% of the women respectively. Only 4% of the women did further studies and got graduated. Though three-forth women were literate, most of them (87%) stayed indoors doing household chores [Table 1].

Table 1: Sociodemographic characteristics of the study participants (n=400)

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Basic knowledge about the presence of an umbilical cord was absent among one-third of the study participants (140, 35%). Among the 260 (65%) women who knew about the umbilical cord, 240 (91.66%) were aware of the presence of blood within the umbilical cord. 180 (69.23%) were aware of the presence of stem cells within the blood, and they can be used in curing disease. Television acted as the major source of information among all those women aware of cord stem cell banking. Eighty-five percent of the study participants were interested in UCB banking and wanted to know more about stem cells to be aware of it. 88.23% of the above participants (N = 340) wanted the attending doctor to explain to them more about stem cells (i.e., 75% of total study participants). 50% of total participants and 52.9% of those who wanted further knowledge were willing to do cord stem cell preservation in a future pregnancy. When inquiring about the reason behind the denial of cord stem cell banking, most of them (80, 40%) women felt that banking is expensive whereas 60 (30%) women do not believe in the procedure, and the remaining 60 (30%) women felt cord stem cell banking as culturally and socially unacceptable. None of the study participants had done cord stem cell banking in the previous pregnancy. Moreover, neither of the study participants is willing to do cord stem cell banking in the current pregnancy.

If provided at affordable cost, 30% (120) of participants wanted to go for cord stem cell banking (private banking) in a future pregnancy. 80% (320) of the total participants were ready to donate their child's cord to public banks. A majority (40%) among the nonaccepting population cited the cost as a reason for nonacceptance [Table 2]. [Table 3] shows that when doctor creates awareness about cord stem cell banking and motivate them, the acceptance of cord stem cell is better. Having prior knowledge about cord stem cell banking can improve the acceptance and usage in a future pregnancy. Hence, awareness should be created despite gravid status.

Table 2: Reason for nonacceptance of cord stem cell banking among participants (n=200)

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Table 3: Association between acceptance of cord stem cell banking and other selected variables (n=400)

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Discussion

Cord blood banking and donation have been a choice for parents for the past quarter century, yet the knowledge and awareness of these options, and consistency of information rendered to parents, remain low. This study aims to explore the expectant mother's awareness and acceptance of cord blood banking and parent and preferred source of information on this topic. It is visible from the study that participants' awareness of cord stem cell banking is not adequate. Only 20% of the participants were aware of this procedure which is similar to the study done by Pandey et al.^[9] in India. From their study, they established that only 26.5% of the pregnant women who took part in the study knew about UCB. Despite the literacy rate, the awareness noted among the women is comparatively good. When talking about the source of information among them, television acts as a major source, which is also similar to the study done by Dinç et al.^[10] It is also recommended by them that those giving ANC and perinatal care need to offer accurate and scientific counseling services on this subject to the expectant parents to improve their knowledge and awareness for better practice. Participants wish to know more about cord stem cell banking like the participants of all other studies and they want their physician to be the major source. As Peberdy et al.^[11] said that the attitude of the participants will improve in a good manner when the doctor provides quality information and motivate the participants.

The uncertainty and misconception can be avoided if a person who is an expert on the topic acts as the source of information. When deciding to donate, expense acts as a major factor in choosing the bank. Moreover, it is to be considered that if provided at an affordable cost most of the population would opt to donate to the private cord blood bank. As Pandey et al.^[9] said that less awareness with regard to the public banks among the population is the major reason behind it. The American College of Obstetricians and Gynecologists, American Academy of Pediatrics, and American Society of Bone Marrow Transplant do not advocate private storage unless there is an identified need in the family in which banked cord blood would offer a benefit.^[12],[13] Obstetricians should presume that pregnant women are poorly enlightened about cord blood banking.

One of the goals of ANC should be to ensure that every pregnant woman must have the possibility to make a well-informed decision about cord blood banking.^[14] It is to be noted that education never goes futile as it is noted from the study that awareness helps in deciding to donate in future pregnancies. Despite its value, some limitations should be considered when interpreting the study findings. This study is entirely hospital-based. Second, it has included only the expectant mothers. Not only the expectant mothers are deciding factor in donating but the expectant father, their family members, and friends can also influence the decision-making process. Hence, it is also essential to educate them.

Conclusion

The acceptance of cord stem cell banking is not up to the mark among antenatal women. Knowledge is the key factor, and if it is lacking, acceptance and usage among people will also be affected. Consulting physician has the sole responsibility to emphasize the importance of cord stem cell banking and avoid uncertainty and misconception about the procedure. Donations to public cord stem cell banks can also be improved only with the help of proper education by experts in the field. Education in any stage never goes in futile as it is noted from the study that awareness helps in deciding to donate in future pregnancies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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