Magnesium Sulfate During Childbirth

Antenatal Magnesium Sulfate Prevents Cerebral Palsy in Preterm Infants

Premature babies have lower survival rates than full-term infants, and those that survive have an increased chance of developing lifelong disabilities such as cerebral palsy. During the birthing process, their fragile bodies are highly susceptible to hypoxic-ischemic encephalopathy (brain damage caused by oxygen deprivation) and other injuries. Even if they make it through the birthing process relatively unscathed, they will likely need round-the-clock care in the NICU until their organs are more developed and they have stronger defenses against infection.

If doctors suspect that a pregnant patient is about to deliver prematurely, they can administer magnesium sulfate therapy to protect the unborn baby’s brain. There are several neuroprotective effects of this treatment, such as increasing cerebral blood flow, decreasing damage from inflammation, and stabilizing membranes. Indications for giving a woman magnesium sulfate include:

Magnesium Sulfate During Childbirth

Recent Meta-Analysis Provides More Details About Effects of Magnesium Therapy

Previous research has shown that magnesium sulfate therapy reduces the incidence of cerebral palsy and other major movement-related disabilities. A recent meta-analysis, published by Caroline A. Crowther (University of Adelaide in Australia) and her colleagues, offers further support for the administration of magnesium sulfate therapy in imminent premature births.

Among the treatment group, they found a significantly reduced risk of cerebral palsy, and no increase in mortality. They note that “there appear to be no substantial short- or long-term complications for the mother or fetus from treatment with antenatal magnesium sulfate.” However, there are certain situations in which magnesium sulfate use is contraindicated. The authors of this paper also stress the importance of collecting information on severe negative outcomes in mothers, rare though they may be.

Additionally, they found neuroprotective benefits in all the subgroups they looked at, which varied based on reasons for preterm birth, preterm gestational age, and dosage regimens. However, maternal side effects increase with higher total dose (Bain et al. as cited within Crowther et al. 2017). Therefore, the authors suggest that “at a clinical level it may be prudent to limit treatment to times close to birth and to minimise the dose of magnesium used to a 4-g bolus loading dose with or without a maintenance dose of 1 g/hour.”

Crother et al. conclude that if appropriate guidelines are followed, widespread use of magnesium sulfate therapy could lead to “significant global health benefits.”


Sources:

Bain ES, Middleton PF, Crowther CA. Maternal adverse effects of different antenatal magnesium sulphate regimens for improving maternal and infant outcomes: a systematic review. BMC Pregnancy and Childbirth 2013 13:195. Pmid:24139447

Crowther CA, Middleton PF, Voysey M, Askie L, Duley L, Pryde PG, Marret S, Doyle LW, AMICABLE Group. Assessing the neuroprotective benefits for babies of antenatal magnesium sulphate: An individual participant data meta-analysis. PLoS medicine 2017 4:14(10):e1002398.

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