Intrapartum Magnesium Sulfate and the Potential for Cardiopulmonary Drug–Drug Interactions

The scientific literature provides extensive evidence of widespread magnesium deficiency and the potential need for magnesium repletion in diverse medical conditions. Magnesium is an essential element required as a cofactor for over 300 enzymatic reactions and is thus necessary for the biochemical functioning of numerous metabolic pathways. Inadequate magnesium status may impair biochemical processes dependent on sufficiency of this element. Emerging evidence confirms that nearly two-thirds of the population in the western world is not achieving the recommended daily allowance for magnesium, a deficiency problem contributing to various health conditions. This review assesses available medical and scientific literature on health issues related to magnesium. A traditional integrated review format was utilized for this study. Level I evidence supports the use of magnesium in the prevention and treatment of many common health conditions including migraine headache, metabolic syndrome, diabetes, hyperlipidemia, asthma, premenstrual syndrome, preeclampsia, and various cardiac arrhythmias. Magnesium may also be considered for prevention of renal calculi and cataract formation, as an adjunct or treatment for depression, and as a therapeutic intervention for many other health-related disorders. In clinical practice, optimizing magnesium status through diet and supplementation appears to be a safe, useful, and well-documented therapy for several medical conditions.

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“…Medications in common usage (e.g., some antibiotics, antacids, and hypertensive drugs) diminish absorption of Mg. See Table 8 [6, 27]. …”

Section: Resultsmentioning

confidence: 99%

The Importance of Magnesium in Clinical Healthcare

2017

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“…Also, one should be aware of possible cardiopulmonary drug interactions among pregnant women who receive magnesium sulfate. Thus, cardiac arrest was documented in 5 of 53 (9.3%) women who additionally received furosemide [6]. In our case of an AV block III°, no additional drug interaction could be identified, but the electrolyte imbalance was considered to be the trigger as other arrhythmogenic causes were absent.…”

Section: Discussionmentioning

confidence: 88%

Tocolysis for in utero Surgery: Atosiban Performs Distinctly Better than Magnesium Sulfate

et al. 2017

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Introduction: To compare tocolysis with magnesium sulfate versus atosiban regarding the occurrence of short-term preterm labor and maternal side effects during and after open fetal myelomeningocele (MMC) repair. Material and Methods: A prospective nonrandomized cohort study was performed including 30 fetal MMC cases. The first 15 cases (group 1) received magnesium sulfate according to the MOMS protocol. In the following 15 cases (group 2), magnesium sulfate was substituted by atosiban. Chorioamniotic membrane separation (CMS), premature prelabor rupture of the fetal membranes (PPROM), preterm delivery <3 weeks after fetal MMC repair, and maternal complications due to the tocolytic medication were the major endpoints. Results: In both groups, one CMS but no PPROM was diagnosed <3 weeks after fetal MMC repair. One patient of group 2 delivered <3 weeks after fetal MMC repair because of an intraoperative placental abruption at 25 weeks. All women of group 1 showed an electrolyte imbalance during magnesium sulfate administration. One woman of group 1 developed several episodes of a third-degree atrioventricular block within the first 3 days after fetal surgery. Lethargy was found in all women during magnesium sulfate therapy. No maternal side effects were found under atosiban. Discussion: The use of atosiban resulted in an almost identical short-term uterine outcome without any serious maternal complications as seen when magnesium sulfate was given. Thus, the authors suggest using atosiban instead of magnesium sulfate in the context of open fetal surgery.

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“…Signs and symptoms of toxicity are other major issues of concern. Magnesium sulfate interacts with other tocolytics and plays a synergistic effect on adverse maternal outcomes, including pulmonary edema and cardiovascular events [32]. Those outcomes were not disclosed with close monitoring during the one-year observational period.…”

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confidence: 99%

Use of Medication for Preterm Labor: Retrospective Cohort Study in a Single Tertiary Center in Wuhan, China

Liu¹,

Zhang²,

Zhang³

et al. 2023

Preprint

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Background Prevention and treatment in preterm birth are still under intensive investigation. A gap exists between evidence-based recommendations and clinical practice. A deeper understanding of the prevalence of medication use is an essential step toward improving the care of pregnant women. This study aimed to address this issue.Methods A retrospective cohort was conducted between December 2018 and November 2019 in Tongji Hospital (Wuhan). In total, 878 pregnant women were enrolled. Information on maternal characteristics, medication prescription, maternal outcomes (including post-partum hemorrhage), and neonatal outcomes (including APGAR score, birthweight, neonatal intensive care unit (NICU) admission, cardiopulmonary and neurological diseases) in the linking system were retrieved.Results The overall coverage of the common medications, including antenatal corticosteroids (ACS), magnesium sulfate, tocolytics, and progesterone, was 84.5%, 52.8%, 24.9%, and 13.3%, respectively. The treatment plan varied widely regarding the regimen, dosing, duration, and combination of these drugs. Specifically, tocolytic maintenance, which means the administration duration of more than 48 hours in this study, increased the risk of post-partum hemorrhage; it also significantly increased birthweight, but was not a risk factor of large-for-gestational-age (LGA).Conclusions This retrospective study in a single tertiary center disclosed that obstetric medications for preterm labor are highly individualized and do not strictly conform to current guidelines. This phenomenon is not uncommon in other countries. Clinical practice and evidence-based recommendations need to be carefully balanced; more studies are warranted to provide high-quality evidence to aid clinical decisions.

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Intrapartum Magnesium Sulfate and the Potential for Cardiopulmonary Drug–Drug Interactions

Cited by 7 publications

References 31 publications

The Importance of Magnesium in Clinical Healthcare

The Importance of Magnesium in Clinical Healthcare

Tocolysis for in utero Surgery: Atosiban Performs Distinctly Better than Magnesium Sulfate

Use of Medication for Preterm Labor: Retrospective Cohort Study in a Single Tertiary Center in Wuhan, China

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