An integrative review of the side effects related to the use of magnesium sulfate for pre-eclampsia and eclampsia management

Abstract

BackgroundPre-eclampsia/eclampsia is one of the most common causes of maternal and perinatal morbidity and mortality in low and middle income countries. Magnesium sulfate is the drug of choice for prevention of seizures as part of comprehensive management of the disease. Despite the compelling evidence for the effectiveness of magnesium sulfate, concern has been expressed about its safety and potential for toxicity, particularly among providers in low- and middle-income countries. The purpose of this review was to determine whether the literature published in these global settings supports the concerns about the safety of use of magnesium sulfate.MethodsAn integrative review of the literature was conducted to document the known incidences of severe adverse reactions to magnesium sulphate, and specific outcomes of interest related to its use. All types of prospective clinical studies were included if magnesium sulfate was used to manage pre-eclampsia or eclampsia, the study was conducted in a low- or middle-income country, and the study included the recording of the incidence of any adverse side effect resulting from magnesium sulfate use.ResultsA total of 24 studies that compared a magnesium sulfate regimen against other drug regimens and examined side effects among 34 subject groups were included. The overall rate of absent patellar reflex among all 9556 aggregated women was 1.6%, with a range of 0-57%. The overall rate of respiratory depression in 25 subject groups in which this outcome was reported was 1.3%, with a range of 0–8.2%. Delay in repeat administration of magnesium sulfate occurred in 3.6% of cases, with a range of 0-65%. Calcium gluconate was administered at an overall rate of less than 0.2%. There was only one maternal death that was attributed by the study authors to the use of magnesium sulfate among the 9556 women in the 24 studies.ConclusionConcerns about safety and toxicity from the use of magnesium sulfate should be mitigated by findings from this integrative review, which indicates a low incidence of the most severe side effects, documented in studies that used a wide variety of standard and modified drug regimens. Adverse effects of concern to providers occur infrequently, and when they occurred, a delay of repeat administration was generally sufficient to mitigate the effect. Early screening and diagnosis of the disease, appropriate treatment with proven drugs, and reasonable vigilance for women under treatment should be adopted as global policy and practice.

Stridor: a rare complication of magnesium sulfate therapy in a pregnant patient

“…Magnesium causes hypocalcaemia by inhibiting parathyroid hormone secretion and increases urinary excretion of calcium. 2,3 Few case reports of symptomatic hypocalcaemia secondary to magnesium sulfate were published, one of the cases was critically ill eclamptic patient treated with large dose of magnesium sulphate and she had tetany when her serum magnesium was 10 mg/ dl and her serum calcium was 6.7 mg/dl.…”

“…The eclampsia trial collaborative group concluded that the Magnesium sulfate reduced the hazard of frequent convulsions in eclamtiptic patient by 52% when compared with diazepam. 2 Magpic trial reported that the Preeclampsia patient had 58% lower risk of getting eclampsia than the placebo group. 2 The serum magnesium level should be between 4-7 meq/l to prevent eclampsia.…”

“…2 Magpic trial reported that the Preeclampsia patient had 58% lower risk of getting eclampsia than the placebo group. 2 The serum magnesium level should be between 4-7 meq/l to prevent eclampsia. Magnesium acts via a number of mechanisms, such as decreasing calcium influx by blocking N-methyl D-aspartate receptors causing vasodilatation of cerebral blood vessels and reduces the cerebral vasospasm.…”

“…Magnesium acts via a number of mechanisms, such as decreasing calcium influx by blocking N-methyl D-aspartate receptors causing vasodilatation of cerebral blood vessels and reduces the cerebral vasospasm. 2,3 Magnesium sulfate can cause several side effects such as flushing, nausea muscle weakness, respiratory depression, hypotension, hypocalcaemia, especially in patient with impaired kidneys function. Magnesium causes hypocalcaemia by inhibiting parathyroid hormone secretion and increases urinary excretion of calcium.…”

“…Preeclampsia is one of leading cause of maternal death and perinatal morbidity and mortality. 2 Eclampsia is one of major complication of Preeclampsia, affects 0.56 per 1000 pregnant women in developed countries.…”