Maternal Magnesium Sulphate Exposure Predicts Neonatal Magnesium Blood Concentrations

Sherwin, Catherine M.T.; Balch, Alfred H.; Campbell, S.; Fredrickson, Jeunesse; Clark, Erin; Varner, Michael W.; Stockmann, Chris; Korgenski, E. Kent; Bonkowsky, Joshua L.; Spigarelli, Michael G.

doi:10.1111/bcpt.12166

Cited by 19 publications

(20 citation statements)

References 35 publications

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“…The results from the study by Marret et al (2008) also support the positive relationship between magnesium levels in cord blood and maternal blood [ 24 ]. Although the influence of other maternal factors (e.g., method of delivery and multiple gestations) have been proposed [ 21 ], their role in predicting neonatal magnesium concentrations has not been confirmed. As suggested for sMg concentration in healthy pregnant women without magnesium supplementation, the cord blood mean (and 95% CI) for total sMg concentration could differ from the normal reference interval reflecting an adequate fetal status.…”

Section: Resultsmentioning

confidence: 99%

“…The full texts of the remaining 179 studies were reviewed and 51 were eligible as they reported magnesium levels in preterm and/or term infants before, at, and/or after birth. Studies were excluded if they reported mean magnesium levels that were clearly outliers among the collected data based on clinical expert opinion (JR); this included 4 studies [ 19 , 20 , 21 , 22 ].…”

Section: Methodsmentioning

confidence: 99%

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Serum Magnesium Levels in Preterm Infants Are Higher Than Adult Levels: A Systematic Literature Review and Meta-Analysis

et al. 2017

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Magnesium (Mg) is an essential mineral in the body, impacting the synthesis of biomacromolecules, bone matrix development, energy production, as well as heart, nerve, and muscle function. Although the importance of Mg is evident, reference values for serum Mg (sMg) in pediatric patients (more specifically, in neonates) are not well established. This systematic literature review and meta-analysis (using 47 eligible studies) aims to quantify normal and tolerable ranges of sMg concentrations during the neonatal period and to highlight the factors influencing Mg levels and the importance of regulating sMg levels during pregnancy and birth. In newborns without Mg supplementation during pregnancy, magnesium levels at birth (0.76 (95% CI: 0.52, 0.99) mmol/L) were similar to that of mothers during pregnancy (0.74 (95% CI: 0.43, 1.04) mmol/L), but increased during the first week of life (0.91 (95% CI: 0.55, 1.26) mmol/L) before returning to adult levels. This pattern was also seen in newborns with Mg supplementation during pregnancy, where the average was 1.29 (95% CI: 0.50, 2.08) mmol/L at birth and 1.44 (95% CI: 0.61, 2.27) mmol/L during the first week of life. Factors influencing these levels include prenatal Mg supplementation, gestational age, birth weight, renal maturity/function, and postnatal Mg intake. Elevated Mg levels (>2.5 mmol/L) have been associated with an increased risk of mortality, admission into intensive care, hypotonia, hypotension, and respiratory depression but sMg concentrations up to 2.0 mmol/L appear to be well tolerated in neonates, requiring adequate survey and minimal intervention.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Serum Magnesium Levels in Preterm Infants Are Higher Than Adult Levels: A Systematic Literature Review and Meta-Analysis

et al. 2017

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“…With regard to the fetal and/or neonatal mortality outcome, interpretation is difficu lt due to the impact of the Okusanya et al study, which reversed the relation. The significance of this is unclear, although neonatal magnesium levels are known to correlate with maternal dosing of magnesium and exposure to magnesium sulfate is associated with NICU admission in a dose‐response relationship . However, this trend was not found in other key studies including the MAGPIE trial .…”

Section: Discussionmentioning

confidence: 98%

Alternative regimens of magnesium sulfate for treatment of preeclampsia and eclampsia: a systematic review of non‐randomized studies

Pratt

Niedle

Vogel

et al. 2015

Acta Obstet Gynecol Scand

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Introduction The optimal dosing regimen of magnesium sulfate for treating preeclampsia and eclampsia is unclear. Evidence from the Cochrane review of randomized controlled trials (RCTs) was inconclusive due to lack of relevant data. Material and methods To complement the evidence from the Cochrane review, we assessed available data from non‐randomized studies on the comparative efficacy and safety of alternative magnesium sulfate regimens for the management of preeclampsia and eclampsia. Sources included Medline, EMBASE, Popline, CINAHL, Global Health Library, African Index Medicus, Biological abstract, BIOSIS and reference lists of eligible studies. We selected non‐randomized study designs including quasi‐RCTs, cohort, case‐control and cross‐sectional studies that compared magnesium sulfate regimens in women with preeclampsia or eclampsia. Results Of 6178 citations identified, 248 were reviewed in full text and five studies of low to very low quality were included. Compared with standard regimens, lower‐dose regimens appeared equally as good in terms of preventing seizures [odds ratio (OR) 1.02, 95% confidence interval (CI) 0.46–2.28, 899 women, four studies], maternal morbidity (OR 0.47, 95%CI 0.32–0.71, 796 women, three studies), and fetal and/or neonatal mortality (OR 0.87, 95%CI 0.38–2.00, 800 women, four studies). Comparison of loading dose only with maintenance dose regimens showed no differences in seizure rates (OR 0.99, 95%CI 0.22–4.50, 146 women, two studies), maternal morbidity (OR 0.53, 95%CI 0.15–1.93, 146 women, two studies), maternal mortality (OR 0.63, 95%CI 0.05–7.50, 146 women, two studies), and fetal and/or neonatal mortality (OR 0.49, 95%CI 0.23–1.03, 146 women, two studies). Conclusion Lower‐dose and loading dose‐only regimens could be as safe and efficacious as standard regimens; however, this evidence comes from low to very low quality studies and further high quality studies are needed.

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“…The mother only received the 4 g bolus dose before the baby was born and was kept on 1 g/hour for a total of 24 h. However, it is well known that magnesium sulfate crosses the placenta and readily distributes into the amniotic fluid and the fetal compartment [10]. Neonatal adverse effects correlate with mean maternal and neonatal magnesium concentrations [11]. Several observational studies showed that neonatal adverse effects were significantly associated with increasing concentrations of magnesium ions in the maternal circulation [12,13].…”

Section: Discussionmentioning

confidence: 99%

Maternal Mitochondrial Encephalomyopathy, Lactic Acidosis and Stroke-Like Episodes Syndrome and Neonatal Magnesium Toxicity: A Case Report

Tinier¹,

Lorenzini²,

Joal³

et al. 2017

Gynecol Obstet

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Introduction: Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome is a progressive disorder associated with neurologic, cardiac, neuromuscular, hepatic, metabolic and gastrointestinal dysfunction, including potential anesthetic and obstetrical complications. Increased susceptibility to drugs in patient with MELAS syndrome can be due to drug-induced mitochondrial toxicity and/or decreased elimination. We present here a case of severe neonatal magnesium sulfate toxicity in the context of MELAS syndrome.

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Maternal Magnesium Sulphate Exposure Predicts Neonatal Magnesium Blood Concentrations

Cited by 19 publications

References 35 publications

Serum Magnesium Levels in Preterm Infants Are Higher Than Adult Levels: A Systematic Literature Review and Meta-Analysis

Serum Magnesium Levels in Preterm Infants Are Higher Than Adult Levels: A Systematic Literature Review and Meta-Analysis

Alternative regimens of magnesium sulfate for treatment of preeclampsia and eclampsia: a systematic review of non‐randomized studies

Maternal Mitochondrial Encephalomyopathy, Lactic Acidosis and Stroke-Like Episodes Syndrome and Neonatal Magnesium Toxicity: A Case Report

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