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Indian J Community Med
Indian J Community Med
IJCM
Indian J Community Med
Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine
0970-0218
1998-3581
Wolters Kluwer - Medknow India

IJCM-49-654
10.4103/ijcm.ijcm_779_23
Short Communication
Awareness and Attitude of Pregnant Couple Toward Umbilical Cord Blood Banking in Telangana: A Cross-sectional Study
Anandgaonkar Rohan K. 1
Motwani Rohini 1
Ramaswamy Gomathi 2
Patnaik Nabnita 3
1 Department of Anatomy, All India Institute of Medical Sciences, Hyderabad, Telangana, India
2 Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Hyderabad, Telangana, India
3 Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
Address for correspondence: Dr. Rohini Motwani, Associate Professor, Department of Anatomy, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India. E-mail: rohinimotwani@gmail.com
Jul-Aug 2024
09 7 2024
49 4 654657
20 11 2023
23 2 2024
Copyright: © 2024 Indian Journal of Community Medicine
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Banking of umbilical cord blood (UCB) is performed to collect and store umbilical cord stem cells. Both public and private cord blood banks have been established around the world. The study aimed to determine the level of awareness of UCB banking among pregnant couples and to assess the attitude of the couples toward UCB banking. We also tried to explore the factors influencing the UCB banking donation and the couple’s expectations of UCB banking in the future. A prevalidated questionnaire on UCB banking was administered, and the interview was conducted among the same pregnant couples (both husband and wife) attending the obstetrics and gynecology (OBG) outpatient department (OPD). Only 28% (N = 121) of the participants had heard of UCB banking, and only 12% had correct knowledge of UCB banking. Only 4.9% of participants had heard of public or private UCB banks. Only one couple of 121 has stored UCB in their previous pregnancy, and about 36% of couples were willing to store their newborn’s UCB in the present pregnancy. Poor understanding continues to be a significant barrier to reaping the benefits of UCB and preservation. Obstetricians and pediatricians should take a more active role in educating patients about the benefits and drawbacks of UCB banking.

Banking
pregnant couples
stem cell
umbilical cord blood
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pmcINTRODUCTION

Umbilical cord blood (UCB) banking, which has ten times the amount of hematopoietic stem cells (HSCs) compared with bone marrow, is gearing up for a new era of medicine.[1] UCB can be collected immediately after the birth of a newborn, when the cord is still attached to the placenta, from the placental side of the umbilical cord, which does not harm the normal delivery process.[2] Since the first successful UCB stem cell transplant in Paris (France) in 1988 on a 6 years old with Fanconi anemia,[3] more than 35,000 such transplants have been conducted globally. There are two main methods of UCB banking: public cord blood banking and private cord blood banking. Public cord blood banks collect, process, and store cord blood units from multiple donors. These units are then made available for patients who need a stem cell transplant but do not have a suitable matched donor in their family. Public cord blood banks follow strict guidelines and regulations to ensure the quality and safety of the collected units.[4] Private cord blood banks allow families to store their baby’s cord blood for their own potential future use. This service comes at a cost, and the stored cord blood is reserved exclusively for the donor family.[4] With this study, we aim to investigate the level of awareness of pregnant couples about UCB banking and to assess the attitude of the couples toward UCB banking in the Telangana region. We also tried to explore the factors influencing the UCB banking donation and the couple’s expectations of UCB banking in the future.

METHODOLOGY

This study is a cross-sectional study conducted at the outpatient department (OPD) of the obstetrics and gynecology (OBG) department, All India Institute of Medical Sciences Bibinagar, Hyderabad, approved by the Institute Ethics Committee (IEC) and Institute Research Body (IRC) (IEC number: AIIMS/BBN/IEC/JULY/2022/181). Written informed consent was obtained from the participants who were willing to participate in the study.

Sampling strategy

The sample size calculated was 121, assuming 50% of the pregnant women would be aware of UCB, 20% relative precision, 80% power, 95% confidence interval, and 20% nonresponse rate.[5] Pregnant couples of any trimester attending the antenatal OPD of the OBG department and willing to participate in the study were included in the study. Unwillingness to participate in the study and pregnant women attending OPD without husbands were excluded from the study. The sampling strategy included stratified random sampling. Considering feasibility, 10 pregnant couples were recruited per day. The average monthly attendance during the previous month was considered the sampling frame to decide upon the sampling interval. The study participants were recruited till the desired sample size was reached.

Participants were informed about the aim of the study, duration of participation, declaration of confidentiality, and voluntary participation. Face-to-face interviews were conducted, using a standardized, prevalidated questionnaire in the local language for better communication, and data were recorded. The questionnaire was divided into four categories. Section A contained the participant’s demographic and obstetric details, Section B included questions about the awareness of the pregnant couple about UCB banking, Section C was about their knowledge regarding the private and public banking options available in Telangana, Section D was to assess their attitude toward UCB banking and donation and to determine the factors influencing donation of UCB. After collecting the responses, the investigators provided answers to educate the participants to make them aware of the myths and realities of UCB banking depending on the willingness of the participants.

Statistical analysis

Data were entered in Microsoft Excel, and further statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 16. The continuous variables such as age, educational status, and weeks of pregnancy were summarized as mean and standard deviation (SD) or median interquartile range (IQR) based on the distribution of the data. The outcome variables, such as awareness status of UCB, banking options, and attitude toward UCB, were summarized as proportions. The Chi-square test with an unpaired Student’s t-test was used to assess the association between the outcome and the independent variables. A P value of less than 0.05 was considered statistically significant.

RESULTS

A total of 121 expecting couples participated in this study, of which 38 (31.4%) pregnant females were primigravida and 83 (68.6%) were multigravida. Around 82% of women were between the age groups of 21 and 30 years. In terms of educational status, 3.3% of women and 4.9% of husbands had completed their postsecondary education, 40.50% of women and 55.3% of husbands had completed their graduation, 53.7% of women and 38% of husbands had finished their secondary education, and 2.4% of women and 1.6% of husbands were illiterate. Over half of spouses were employed in the private sector, whereas 89.2% of women were unemployed [Table 1].

Table 1: Demographic details of the participants (n=121)

Characteristics	Number of participants	Percentage	
Age in years (of pregnant women)			
    18 to 20	13	10.7	
    21 to 25	51	42.1	
    26 to 30	48	39.7	
    31 to 37	9	7.4	
Parity			
    Primigravida	38	31.4	
    Multigravida	83	68.6	
Pregnant women’s educational status			
    Illiterate and primary	4	3.3	
    Secondary	64	52.8	
    Graduation and postgraduation	53	43.8	
Husband’s educational status			
    Illiterate and primary	5	4.1	
    Secondary	43	35.5	
    Graduation and PGs	73	60.3	
Pregnant women’s occupational status			
    Employed	13	10.7	
    Non-employed	108	89.2	
Husband’s occupational status			
    Daily wage worker	28	23.1	
    Government service	25	20.6	
    Private sector	68	56.2	

Participant’s awareness or understanding of UCB banking (N = 121)

The overall awareness among the participants of UCB banking was low. Only 28% of them had heard of UCB banking, many of them from school, college, and friends, and only 12% had correct knowledge of it. When it came to public or private UCB banks, only 4.9% of the participants had heard of UCB banks. Only one couple of 121 has stored UCB in their previous pregnancy, and 36.3% of couples were willing to store their UCB in the present pregnancy [Table 2].

Table 2: Awareness and attitude of the pregnant mothers toward umbilical cord blood (UCB) banking (n=121)

Particulars	Number of participants (n=121) (%)	
Aware of UCB banking	34 (28.1)	
Aware of private or public banks	06 (4.9)	
Understanding of UCB banks (a)	14 (11.5)	
Understanding of private UCB banks (b)	30 (24.7)	
Understanding of public UCB banks (c)	40 (33.0)	
Thinking UCB blood banks useful	76 (62.8)	
Ever stored cord blood in a previous pregnancy	01 (0.8)	
Willing to store UCB during the current pregnancy	44 (36.3)	

Attitude toward UCB banking (N = 121)

After gaining an overview of UCB banking through the questionnaires, 62.8% of women found it useful, 36.3% expressed willingness to store UCB in their present pregnancy, 13.6% wanted to store in private UCB banks, 38.6% in public UCB banks, and 47.7% were not sure. Another 14.8% were interested but needed more information before making a choice [Figure 1]. The lack of interest in UCB banking was mainly due to a lack of knowledge (71.4%). When questioned about banking UCB for research, the majority (54.5%) of participants said they would give if it was safe for themselves and their newborn, some (14%) said they would donate in any instance, and a few (1.6%) said they would donate only in exchange for financial compensation. When asked from where or from whom they would prefer to obtain information on this topic, 77.6% said they would contact their obstetricians, 1.6% said they would call a UCB representative, 10.7% said they would approach the Internet, and 9.9% said they would seek information from family or friends [Figure 2].

Figure 1 Willingness to store umbilical cord blood (UCB) stem cells during the current pregnancy as reported by the pregnant women

Figure 2 Preferred source of information related to umbilical cord blood (UCB) banking (N = 121)

Factors influencing donation of UCB among pregnant women [Table 3]

According to our observation, only a few couples were aware of UCB banking but unwilling to store it; a few were unaware but willing to preserve their UCB. When compared to graduate and postgraduate couples (more than 50%), illiterate and elementary educated couples were shown to be hesitant to contribute to UCB (25% moms and 20% husbands). Willingness increased along with the educational status hierarchy. Females who were working (76.9%) were more likely to be willing to store their newborn UCB than those who are unemployed (48.1%). More than 50% of husbands who worked in the private sector showed increased interest in UCB banking after understanding how crucial it is to preserve cord blood stem cells.

Table 3: Factors associated with willingness to donate umbilical cord blood (UCB) among pregnant women

Association factors for willingness to donate UCB	Total number of participants (n=121 (%))	Number of participants willing to donate(n=62 (%))	P	
1. Education of pregnant women			0.384 (1.941)	
    Illiterate and primary	4 (3.3)	1 (25.0)		
    Secondary	64 (52.8)	31 (48.4)		
    Graduation and postgraduation	53 (43.8)	30 (56.6)		
2. Education of husband			0.0748 (5.183)	
    Illiterate and primary	5 (4.1)	1 (20)		
    Secondary	43 (35.5)	18 (41.8)		
    Graduation and postgraduation	73 (60.3)	43 (58.9)		
3. Parity			0.835 (0.0429)	
    Primigravida	38 (31.4)	20 (52.6)		
    Multigravida	83 (68.6)	42 (50.6)		
4. Occupation of pregnant women			0.0498 (3.845)	
    Employed	13 (10.7)	10 (76.9)		
    Non-employed	108 (89.2)	52 (48.1)		
5. Occupation of husband			0.726 (0.638)	
    Daily wage worker	28 (23.1)	13 (46.4)		
    Government service	25 (20.6)	12 (48.0)		
    Private sector	68 (56.2)	37 (54.4)		

CONCLUSION

In the present study, we aimed to determine the awareness of pregnant couples about UCB banking in our hospital setting. Overall general awareness of the pregnant couples was low (12%). The education level of the couples definitely plays an important role in their understanding of the importance of stem cells and their banking as we observed that awareness was more in the women who are graduates and postgraduates.[6] Younger mothers, who were more educated, who belonged to a higher socioeconomic background, and who consulted private hospitals, were more informed by doctors and hence had a heightened awareness of UCB storage. These findings were in accordance with another study conducted in China.[7] Although we predicted increased awareness with greater parity, there was no significant association between women’s awareness and parity. In a detailed interview with the participants, some were of the notion that their own blood would be stored after pregnancy and some were thinking that the newborn’s blood would be stored. Other studies from Canada and Europe also found that inadequate or very poor awareness is the responsible factor.[89] The majority of the women in this study who had some knowledge about UCB donation identified their primary source of information irrespective of age and educational attainment, as being the Internet. This finding contrasted with the study by Bhandari et al.,[10] who reported the primary source of information on UCB among their cohort of women to be the healthcare provider.[1] Many of them were unaware of the public and private UCB banks, but as such we found that awareness of public UCB banks (40%) was more than that of private UCB banks (30%) similar to a multicentric study conducted by Katz G et al. that observed a strong preference for public banking (76.5%) among the pregnant women.[9] A public bank is being proposed as a way to extend the ethnically diversified inventory of UCB units.[11]

Recently, to address the concerns of all stakeholders involved in UCB banking, the Indian Council of Medical Research (ICMR) has published detailed guidelines on UCB banking collection, processing, testing, storage, banking, and release for clinical application, which is very useful for clinicians.[12] According to this, parents who are offered cord blood banking must receive accurate information on the precise benefits of cord blood storage for self-directed use, the operation of private versus public cord blood banks, international status, and the likelihood that private banking will be advantageous relative to the possibility of providing the stored cord blood to a public cord blood bank to help fund a life-saving therapy for someone else.[12] The medical and scientific communities, as well as those involved in all aspects of UCB banking, need to be updated on the proper use of cord blood stem cells; hence, it is necessary to establish ongoing education modules. Policymakers, especially regulators, have a responsibility to raise understanding about the legal status of cord blood stem cells and their applications based on peer-reviewed scientific data, in addition to treating physicians and banking professionals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Acknowledgement

The authors appreciate the expecting couples who were kind enough to take the time to fill out the questionnaires. The authors also appreciate the assistance of Mr. Vishnu Bandela, a third-year medical student, who helped us communicate with patients, as well as Dr. Remya Mary John, a junior resident of the Department of Certification in Maternal Fetal Medicine (CMFM), who helped us with statistical analysis.
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