Magnesium sulfate therapy of preeclampsia: an old tool with new mechanism of action and prospect in management and prophylaxis

Abstract

A disturbed balance between angiogenic and antiangiogenic growth factors is a highly accepted mechanism in the pathogenesis of pregnancy-induced hypertension and proteinuria, which is clinically known as preeclampsia (PE). We investigated the effect of magnesium sulfate (MgSO 4 ) therapy on vascular endothelial growth factor (VEGF), placental growth factor (PlGF), nitric oxide (NO) metabolites, soluble fm-like tyrosine kinase-1 (sFlt-1) and endoglin levels in PE rats and the effect of this treatment on the feto-maternal outcome. The PE group showed hypertension, proteinuria and decreased number and weight of live pups relative to the control group. This result was associated with increased sFlt-1, VEGF receptor-2 (VEGFR-2), VEGFR-3 and endoglin levels but decreased NO metabolites. MgSO 4 therapy ameliorated systolic hypertension and proteinuria and decreased sFlt-1, VEGFR-2, VEGFR-3 and endoglin levels but increased NO metabolites in the treated group. Physiological and biochemical changes and improved pup weight and viability were observed in the treated group. The vasodilator action of MgSO 4 and increased NO production are expected to increase placental blood flow and help fetal nutrition and development. Relief of placental ischemia decreases the production of antiangiogenic growth factors and restores the bioavailability of angiogenic factors (PlGF and VEGF). These changes resulted in better fetal outcome and an improved clinical picture of PE. These findings are promising and encourage further study of the mechanism of action of MgSO 4 to support its widespread use in the prevention and management of the etiopathological changes underlying the vast majority of the manifestations and complications of PE.

Differences in epidemiology of patients with preeclampsia between China and the US (Review)

“…For American pregnant females, it may be useful to prevent PE by lowering the age of pregnancy, reducing multipara, reducing weight appropriately and controlling weight gain during pregnancy. Furthermore, psychological stress may be a risk factor for pregnant females ( 82 , 83 ), which may be related to educational background and work intensity (which may be reflected by their salary). The present results indicated that Chinese females have a similar educational level distribution to Americans.…”

A case of eclampsia complicated by cerebral haemorrhage and iatrogenic hypopharyngeal oedema and haemathoma

“…In eclamptic patients, according to the treatment protocol, we immediately started antioedematous therapy (solution Mannitol, dexamethasone). For the treatment and prevention of new eclamptic seizures, we used MgSO 4 , as it is the first choice medication, useful also as sedative and antihypertensive agent 7,14,16,17,[25][26][27][28][29][30][31][32] . Our main problem was BP regulation, complicated by the need for mechanical ventilation and, later, by fear, anxiety in awaken patient with tracheostomal cannula.…”

Tanshinone II-A Is Protective against Human Umbilical Vein Endothelial Cell Injury after Exposure to Serum from Preeclampsia Patients

“…However, early pregnancy termination to alleviate PE increases both neonatal mortality and morbidity. Magnesium sulfate, which causes prostaglandin release and subsequent dilation of blood vessels, has been occasionally used as a therapeutic drug for PE [12,13,14]. Despite extending gestational age to some extent, magnesium sulfate does not reverse the development of PE but rather alleviates symptoms temporarily.…”