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SMFM debate| Volume 205, ISSUE 4, P296-297, October 2011

Magnesium sulfate for fetal neuroprotection

DOI:https://doi.org/10.1016/j.ajog.2011.02.083
Magnesium sulfate for fetal neuroprotection
Previous ArticleMagnesium sulfate for neuroprotection: now or not yet
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      In the 3 large, well-done randomized placebo-controlled trials, antenatal magnesium sulfate (MgSO4) reduced the risk of cerebral palsy among children who survived early preterm birth. Crowther and colleagues
      • Crowther C.A.
      • Hiller J.E.
      • Doyle L.W.
      • Haslam R.R.
      Effect of magnesium sulfate given for neuroprotection before preterm birth: a randomized controlled trial.
      JAMA. 2003; 290: 2669-2676
      studied 1062 women. Moderate or severe cerebral palsy (inability to walk unaided) was significantly less frequent among children in the MgSO4 group, 3.4% vs 6.6%. In the National Institutes of Health Maternal-Fetal Medicine Units Network trial (the BEAM trial) 2241 women were enrolled.
      • Rouse D.J.
      • Hirtz D.G.
      • Thom E.
      • et al.
      A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy.
      N Engl J Med. 2008; 359: 895-905
      As in the trial of Crowther et al,
      • Crowther C.A.
      • Hiller J.E.
      • Doyle L.W.
      • Haslam R.R.
      Effect of magnesium sulfate given for neuroprotection before preterm birth: a randomized controlled trial.
      JAMA. 2003; 290: 2669-2676
      MgSO4 significantly reduced the risk of moderate to severe cerebral palsy, 1.9% vs 3.5%. Among the offspring of women randomized <28 weeks, the respective risks were 2.7% and 6.1%. Marret et al
      • Marret S.
      • Maroeau L.
      • Follet-Bouhamed C.
      • et al.
      Effect of magnesium sulphate on mortality and neurologic morbidity of the very preterm newborn with two-year neurological outcome: results of the prospective PREAMAG trial.
      Gynecol Obstet Fertil. 2008; 36: 278-288
      studied 573 mothers: MgSO4 lowered the risk of cerebral palsy, 7.0% vs 10.2%. These 3 trials and 2 more (6145 children) are included in a Cochrane Systematic Review that concluded that MgSO4 reduced the risk of cerebral palsy by 32% but had no effect on fetal or infant mortality.
      • Doyle L.W.
      • Crowther C.A.
      • Middleton P.
      • Marret S.
      • Rouse D.
      Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus.
      Cochrane Database Syst Rev. 2009; 1 (CD004661)
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      References

        • Crowther C.A.
        • Hiller J.E.
        • Doyle L.W.
        • Haslam R.R.
        Effect of magnesium sulfate given for neuroprotection before preterm birth: a randomized controlled trial.
        JAMA. 2003; 290: 2669-2676
        View in Article
        • Rouse D.J.
        • Hirtz D.G.
        • Thom E.
        • et al.
        A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy.
        N Engl J Med. 2008; 359: 895-905
        View in Article
        • Marret S.
        • Maroeau L.
        • Follet-Bouhamed C.
        • et al.
        Effect of magnesium sulphate on mortality and neurologic morbidity of the very preterm newborn with two-year neurological outcome: results of the prospective PREAMAG trial.
        Gynecol Obstet Fertil. 2008; 36: 278-288
        View in Article
        • Doyle L.W.
        • Crowther C.A.
        • Middleton P.
        • Marret S.
        • Rouse D.
        Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus.
        Cochrane Database Syst Rev. 2009; 1 (CD004661)
        View in Article

      Article info

      Identification

      DOI: https://doi.org/10.1016/j.ajog.2011.02.083

      Copyright

      © 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.

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