Brain lesions in newborns exposed to high-dose magnesium sulfate during preterm labor

Abstract

High-dosage, tocolytic magnesium sulfate (MgSO 4 ) administered to pregnant women during preterm labor can be toxic, and sometimes lethal, for their newborns (Cochrane Database of Systematic Reviews (relative mortality risk 2.82, 95% confidence interval 1.2-6.6)). Based on the results of the Magnesium and Neurologic Endpoints Trial and the work of many others, a unifying triangular concept is proposed to account for the increased prevalence of brain lesions, with their likely resultant mortality, in neonates and infants exposed to high-dose MgSO 4 in the context of preterm labor. We review the evidence that: (1) elevated circulating levels of serum ionized magnesium occurring in mothers, and therefore in their babies, at the time of delivery are associated with subsequent neonatal intraventricular hemorrhage (IVH); (2) neonatal IVH is strongly associated with lenticulostriate vasculopathy (LSV), an unusual mineralizing lesion involving the thalami and basal ganglia of the neonate; and, (3) exposure to 50 g or more of tocolytic MgSO 4 during preterm labor is associated with the development of LSV.

Effects of antenatal magnesium sulfate treatment for neonatal neuro-protection on cerebral oxygen kinetics

“…For instance, the loading (9) and continuous infusion dose (19) of antenatal MgSO 4 for tocolysis is significantly higher than that used for neuro-protection in the current study. With elevated neonatal circulating magnesium levels known to persist beyond the initial transition to postnatal life (20), exposure to a lower total MgSO 4 dose antenatally, with subsequent differences in neonatal plasma magnesium levels in the first few days of life, may also explain our observation that the difference in cFTOE was confined to the first 24 h of postnatal life.…”

Antenatal magnesium sulfate and the postnatal response of the ductus arteriosus to indomethacin in extremely preterm neonates

“…3 Although the safety and efficacy of MgSO 4 in termgestation preeclampsia have been well established, 4 tocolytic MgSO 4 administered to stall preterm labor has been suggested to be associated with adverse neonatal effects, 5 and its use therefore remains controversial. 6,7 After birth, patent ductus arteriosus (PDA) increases pulmonary blood flow and induces redistribution of systemic blood flow.…”

Effect of magnesium on the cardiovascular system in women

“…Дефицит магния в организме приводит к ускорен-ному старению фибробластов, замедлению синтеза кол-лагеновых и эластиновых волокон и ухудшению меха-нических характеристик ткани [42,43]. Включение маг-ния оротата в комплекс лечебных мероприятий пато-генетически показан пациенткам с пролапсами гени-талий, особенно в профилактике рецидивов после оперативного вмешательства [36,44,45].…”