Title
The use of intravenous magnesium in non-preeclamptic pregnant women : fetal/neonatal neuroprotection The use of intravenous magnesium in non-preeclamptic pregnant women : fetal/neonatal neuroprotection
Author
Faculty/Department
Faculty of Medicine and Health Sciences
Publication type
article
Publication
Berlin ,
Subject
Human medicine
Source (journal)
Archives of gynecology and obstetrics. - Berlin, 1987, currens
Volume/pages
(2014) , p. 1-7
ISSN
0932-0067
ISI
000351467600004
Carrier
E
Target language
English (eng)
Full text (Publishers DOI)
Affiliation
University of Antwerp
Abstract
Purpose To review the effect of intravenous magnesium in obstetrics on fetal/neonatal neuroprotection. Methods A systematic review of published studies. Results Five randomized trials and 4 meta-analyses have shown a significant 32 % reduction of cerebral palsy when administering magnesium sulfate in case of preterm delivery. The pathophysiologic mechanism is not fully unraveled: modulation of the inflammatory process, both in the mother and the fetus, and downregulation of neuronal stimulation seem to be involved. After long-term high-dose intravenous administration of magnesium, maternal and neonatal adverse effects such as maternal and neonatal hypotonia and osteoporosis and specific fetal/neonatal cerebral lesions have been described. In case of administration for less than 48 h at 1 g/h and a loading dose of 4 g, these toxic amounts are not achieved. American, Canadian and Australian guidelines recommend the use of intravenous magnesium in any threatening delivery at less than 32 weeks. The number needed to treat to avoid 1 cerebral palsy is between 15 and 35. Conclusions Intravenous magnesium significantly reduces the risk for cerebral palsy in preterm birth. Open questions remain the optimal dosing schedule, whether or not repeating when delivery has been successfully postponed and a new episode of preterm labor occurs. Some concern has been raised on a too optimistic value for random error which might have led to over-optimistic conclusions in classic meta-analysis. Randomized trials comparing different doses and individual patient data meta-analysis might resolve these issues.
E-info
https://repository.uantwerpen.be/docman/iruaauth/a3293c/7dc5d1a7549.pdf
Full text (open access)
https://repository.uantwerpen.be/docman/irua/e82b53/9486.pdf
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