Randomized investigation of magnesium sulfate for prevention of preterm birth

Cox, Susan M.; Sherman, M. L.; Leveno, Kenneth J.

doi:10.1016/0002-9378(90)91065-k

Cited by 138 publications

(40 citation statements)

References 13 publications

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“…(The decision to dichotomize exposure at the threshold of about 50 g or more was based on our previous work, 34,35 as well as the clinical trial experience from another group of investigators. 36 ) Among these variables, only the receipt of high-dose MgSO 4 remained statistically significant (adj OR 8.3, 95% CI 1.5-45.0, P ¼ 0.01) in multivariable logistic regression.…”

Section: Lsv In Magnetmentioning

confidence: 88%

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

Mittendorf

Dammann

2005

J Perinatol

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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.

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Section: Lsv In Magnetmentioning

confidence: 88%

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

Mittendorf

Dammann

2005

J Perinatol

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“…In the latest trial to test the use of MgSO 4 for neuroprotection the dose was relatively low (median 10.5 g). 16 In two randomized trials, 17,18 however, exposure to 50 g or higher doses has been found to be associated with increased mortality among infants. A case-control study demonstrated increased mortality when the cumulative doses of MgSO 4 sulfate was greater than 48 g, which is equivalent to one day exposure to MgSO 4 at the common tocolytic dose.…”

Section: Discussionmentioning

confidence: 99%

Antenatal exposure to magnesium sulfate and the incidence of patent ductus arteriosus in extremely low birth weight infants

et al. 2007

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Objective: Magnesium sulfate (MgSO 4 ) is the most commonly used tocolytic agent in the US and is also employed as a prophylactic agent against seizures in pre-eclamptic women. MgSO 4 crosses the placenta and its concentration in the newborn usually exceeds that of maternal levels. The purpose of this study was to explore the relationship between antenatal exposure to MgSO 4 and the incidence of patent ductus arteriosus (PDA) in extremely low birth weight infants.Study design: A total of 954 neonates with birth weights between 500 and 1000 g, born at the University of Miami/Jackson Memorial Hospital between January 1995 and December 2004 and surviving for more than 3 days, were followed until death or discharge from the hospital. The incidence of PDA in infants exposed to MgSO 4 was compared with those not exposed and comparisons were also made between infants exposed to different maternal doses of MgSO 4 .Results: The incidence of PDA was significantly higher in the group of infants exposed to MgSO 4 compared with the unexposed control group (67 vs. 60%, P<0.018). When stratified by gestational age the differences were significant only in the group of infants with a gestational age of X26 weeks (58 vs. 49%, P<0.039). Logistic regression analysis to adjust for co-variables indicated an increased risk of PDA with higher doses of MgSO 4 (odds ratio 1.33 confidence interval (CI) 1.12 to 1.58, per 50 g of MgSO 4 ). Conclusion:Antenatal exposure to MgSO 4 is associated with a higher risk of PDA in extremely low birth weight infants and this effect is more significant and dose-related in more mature infants.

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“…The trial was suspended after 15 months of enrollment because of excess pediatric mortality among those exposed to magnesium sulfate compared to those assigned to other tocolytics (AR ¼ 15.2, 95% CI ¼ 4.8 to 25.6). 5,6,17 A random-effects model meta-analysis combining data from this study with one by Cox et al 18 showed a statistically significant association between tocolytic magnesium and total pediatric death (AR ¼ 10.7, 95% CI ¼ 3.9 to 17.6). 2 In addition to these studies, others have demonstrated an association of magnesium exposure with adverse infant outcome.…”

Section: Discussionmentioning

confidence: 55%

Hospitalization and Infant Outcomes among Women Exposed and Unexposed to Tocolysis

2004

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OBJECTIVE:To examine whether infants exposed to tocolytics are at increased risk for selected adverse clinical and hospitalization outcomes. STUDY DESIGN:We conducted a population-based cohort study of women with preterm labor, in Washington State from 1989 to 2001 (N ¼ 79,679), using linked hospitalization records. Relative risks for infant outcomes were estimated using multivariate logistic regression. RESULTS:Adjusted risk estimates for infants exposed to tocolysis were greater for respiratory distress (RR ¼ 1.5, 95% CI 1.4 to 1.6), intubation (RR ¼ 1.4, 95% CI 1.2 to 1.5), and bacterial infection (RR ¼ 1.6, 95% CI 1.4 to 1.8). Exposed infants were also more likely to have birth hospitalizations >2 days (RR ¼ 1.4, 95% CI 1.3 to 1.4), require transfer (RR ¼ 1.5, 95% CI 1.3 to 1.8), have increased hospital costs (RR ¼ 2.3, 95% CI 2.2 to 2.4), and require readmisssion within the first year of life (RR ¼ 1.2, 95% CI 1.1 to 1.3). CONCLUSION:Infants exposed to tocolytics appeared to have relatively poorer hospitalization and clinical outcomes; significant benefits were not observed.

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Randomized investigation of magnesium sulfate for prevention of preterm birth

Cited by 138 publications

References 13 publications

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

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

Antenatal exposure to magnesium sulfate and the incidence of patent ductus arteriosus in extremely low birth weight infants

Hospitalization and Infant Outcomes among Women Exposed and Unexposed to Tocolysis

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