Should magnesium sulfate be used for fetal neuroprotection?

Article

Cerebral palsy is a nightmare for a child, parents and obstetrician.

Preterm birth is a major risk factor for CP; infants born at less than 34 completed weeks' gestation constitute about 25% of all new cases. Magnesium sulfate is known to reduce spontaneous and induced myometrial contractions and has been used widely in obstetrics as a tocolytic agent.1,2 However, its value in that setting has been questioned because it has not been shown to reduce the frequency of delivery within 48 hours compared with placebo or no therapy (relative risk [RR], 0.75; 95% confidence interval [CI], 0.54-1.03).3,4 Recently, however, investigators hypothesized that magnesium sulfate could provide neuroprotection through reduced vascular instability and hypoxia-reperfusion injury and/or reductions in cytokine- or excitatory amino acid-induced damage. This has led investigators to evaluate its potential in preventing CP.

Clinical basis for recommending magnesium sulfate as a neuroprotectant

Given this evidence, magnesium sulfate treatment before an anticipated early preterm birth may be protective against CP. However, one must be cautious, because the benefits of antenatal treatment were identified only in secondary analyses. It should also be noted that no life-threatening events or maternal deaths were reported in any of the more than 3,000 women who received the drug in the randomized trials.13

Based on these recent findings, ACOG recognized that none of the individual studies found a benefit with respect to the primary outcome and that although the cumulative evidence suggests a neuroprotective effect, no firm recommendation was issued for or against therapy. The decision was left to the individual physician who should, if he or she chooses to use magnesium for this purpose, "develop specific guidelines regarding inclusion criteria, treatment regimens, concurrent tocolysis, and monitoring in accordance with one of the larger trials."14

Recent Videos
Revi System shows efficacy against urgency urinary incontinence | Image Credit: ics.org.
1 expert is featured in this series.
Researchers highlight risks of breastfeeding while taking Levetiracetam | Image Credit: uwaterloo.ca.
Ipek Ensari, PhD, highlights improved mental health in chronic pelvic pain from physical activity | Image Credit: scholars.mssm.edu
New pSNM system empowers patients in urge urinary incontinence treatment | Image Credit: trinityhealthmichigan.org.
Jannah Thompson, MD, highlights battery free device for UUI management | Image Credit: trinityhealthmichigan.org
Anietie Aliu, PhD, highlights racial barriers to breast cancer screening | Image Credit: bbc.com.
Anietie Aliu, PhD, discusses how to improve breast cancer screening disparities | Image Credit: bbc.com
Jennifer Payne, MD, highlights how to help young women with perimenopause symptoms | Image Credit: uvahealth.com/findadoctor.
Perimenopausal symptoms in young women discussed by Jennifer Payne, MD | Image Credit: uvahealth.com/findadoctor.
Related Content
© 2025 MJH Life Sciences

All rights reserved.