Committee Opinion No 652

doi:10.1097/aog.0000000000001267

Cited by 96 publications

(6 citation statements)

References 9 publications

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“…Magnesium sulphate is recommended for fetal neuroprotection in women at risk of preterm birth although the optimal gestational age for its use remains uncertain [ 4 , 19 ],[ [31] , [32] , [33] , [34] ]. We found that in babies randomised at 30 to <32 weeks (51% of the cohort) there were no differences between magnesium exposed and placebo groups in any white matter region, whereas in the babies randomised at 32 <34 weeks (49% of the cohort) there was higher FA in the magnesium exposed group, although this was restricted to the left inferior longitudinal fasciculus.…”

Section: Discussionmentioning

confidence: 99%

RETRACTED: Effect of antenatal magnesium sulphate on MRI biomarkers of white matter development at term equivalent age: The magnum study

et al. 2020

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Background Magnesium sulphate given to women immediately prior to very preterm birth protects the perinatal brain, so fewer babies die or develop cerebral palsy. How magnesium sulphate exerts these beneficial effects remains uncertain. The aim of the MagNUM Study was to assess the effect of exposure to antenatal magnesium sulphate on MRI measures of brain white matter microstructure at term equivalent age. Methods Nested cohort study within the randomised Magnesium sulphate at 30 to <34 weeks’ Gestational age Neuroprotection Trial (MAGENTA). Mothers at risk of preterm birth at 30 to <34 weeks’ gestation were randomised to receive either 4 g of magnesium sulphate heptahydrate [8 mmol magnesium ions], or saline placebo, infused over 30 min when preterm birth was planned or expected within 24 h. Participating babies underwent diffusion tensor MRI at term equivalent age. The main outcomes were fractional anisotropy across the white matter tract skeleton compared using Tract-based Spatial Statistics (TBSS), with adjustment for postmenstrual age at birth and at MRI, and MRI site. Researchers and families were blind to treatment group allocation during data collection and analyses. Findings Of the 109 participating babies the demographics of the 60 babies exposed to magnesium sulphate were similar to the 49 babies exposed to placebo. In babies whose mothers were allocated to magnesium sulphate, fractional anisotropy was higher within the corticospinal tracts and corona radiata, the superior and inferior longitudinal fasciculi, and the inferior fronto-occipital fasciculi compared to babies whose mothers were allocated placebo ( P < 0.05). Interpretation In babies born preterm, antenatal magnesium sulphate exposure promotes development of white matter microstructure in pathways affecting both motor and cognitive function. This may be one mechanism for the neuroprotective effect of magnesium sulphate treatment prior to preterm birth. Funding Health Research Council of New Zealand.

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Section: Discussionmentioning

confidence: 99%

RETRACTED: Effect of antenatal magnesium sulphate on MRI biomarkers of white matter development at term equivalent age: The magnum study

et al. 2020

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“…It is usually recommended for neuroprotection for extremely premature fetuses (<32 weeks) and for seizure prophylaxis in patients with preeclampsia. 58 59 However, magnesium is not without risks. One major, albeit uncommon, side effect is respiratory depression.…”

Section: Be Judicious In Magnesium Sulfate Use On Labor and Deliverymentioning

confidence: 99%

General Guidelines in the Management of an Obstetrical Patient on the Labor and Delivery Unit during the COVID-19 Pandemic

et al. 2020

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Novel coronavirus disease 2019 (COVID-19) is a respiratory tract infection that was first identified in China. Since its emergence in December 2019, the virus has rapidly spread, transcending geographic barriers. The World Health Organization and the Centers for Disease Control and Prevention have declared COVID-19 as a public health crisis. Data regarding COVID-19 in pregnancy is limited, consisting of case reports and small cohort studies. However, obstetric patients are not immune from the current COVID-19 pandemic, and obstetric care will inevitably be impacted by the current epidemic. As such, clinical protocols and practice on labor and delivery units must adapt to optimize the safety of patients and health care workers and to better conserve health care resources. In this commentary, we provide suggestions to meet these goals without impacting maternal or neonatal outcomes. Key Points • Novel coronavirus disease 2019 (COVID-19) is a pandemic.• COVID-19 impacts care of obstetric patients.• Health care should be adapted for the COVID-19 pandemic.

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“…Despite strong evidence indicating effectiveness in preventing eclampsia, MgSO 4 is ineffective in delaying preterm birth ( 32 ). Despite weak evidence, MgSO 4 is still recommended by the American College of Obstetricians and Gynecologists for short-term pregnancy prolongation (up to 48 h) to allow the administration of corticosteroids ( 33 ). In a European population-based cohort study, 35% of women with severe pre-eclampsia, eclampsia, or HELLP syndrome received MgSO 4 before delivery.…”

Section: Effects Of Mgso 4 Treatment In Pregnancymentioning

confidence: 99%

Fetal Neuroprotection by Magnesium Sulfate: From Translational Research to Clinical Application

2018

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Despite improvements in perinatal care, preterm birth still occurs regularly and the associated brain injury and adverse neurological outcomes remain a persistent challenge. Antenatal magnesium sulfate administration is an intervention with demonstrated neuroprotective effects for preterm births before 32 weeks of gestation (WG). Owing to its biological properties, including its action as an N-methyl-d-aspartate receptor blocker and its anti-inflammatory effects, magnesium is a good candidate for neuroprotection. In hypoxia models, including hypoxia-ischemia, inflammation, and excitotoxicity in various species (mice, rats, pigs), magnesium sulfate preconditioning decreased the induced lesions’ sizes and inflammatory cytokine levels, prevented cell death, and improved long-term behavior. In humans, some observational studies have demonstrated reduced risks of cerebral palsy after antenatal magnesium sulfate therapy. Meta-analyses of five randomized controlled trials using magnesium sulfate as a neuroprotectant showed amelioration of cerebral palsy at 2 years. A meta-analysis of individual participant data from these trials showed an equally strong decrease in cerebral palsy and the combined risk of fetal/infant death and cerebral palsy at 2 years. The benefit remained similar regardless of gestational age, cause of prematurity, and total dose received. These data support the use of a minimal dose (e.g., 4 g loading dose ± 1 g/h maintenance dose over 12 h) to avoid potential deleterious effects. Antenatal magnesium sulfate is now recommended by the World Health Organization and many pediatric and obstetrical societies, and it is requisite to maximize its administration among women at risk of preterm delivery before 32 WG.

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Committee Opinion No 652

Cited by 96 publications

References 9 publications

RETRACTED: Effect of antenatal magnesium sulphate on MRI biomarkers of white matter development at term equivalent age: The magnum study

RETRACTED: Effect of antenatal magnesium sulphate on MRI biomarkers of white matter development at term equivalent age: The magnum study

General Guidelines in the Management of an Obstetrical Patient on the Labor and Delivery Unit during the COVID-19 Pandemic

Fetal Neuroprotection by Magnesium Sulfate: From Translational Research to Clinical Application

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