Effect of Magnesium on Glomerular Filtration Rate and Recovery of Hypertension in Women with Severe Preeclampsia

Abstract

Introduction: Magnesium sulfate is used for preventing seizures in patients with severe preeclampsia. Previous studies have demonstrated that magnesium plays a significant role in the endothelial function and might have clinically beneficial vasodilating properties. Objectives: This study is aimed at evaluating the effect of magnesium sulfate on the glomerular filtration rate (GFR) during the first 24 h after delivery and during the duration of recovery from hypertension in preeclampsia. Methods: Severe preeclamptic patients who had normal serum creatinine levels (0.4–0.8 mg/dL) were included in the study. Twenty-three women with severe preeclampsia were divided into groups of 9, 8, and 6, and given 1.0, 1.5, and 2.0 g/h of magnesium sulfate, respectively. Magnesium sulfate infusion was used as seizure prophylaxis for 24 h after delivery. The cystatin C-based GFR was monitored for 24 h, and the blood pressure was recorded for 12 weeks postpartum. Results: Despite the minimal improvement of GFR 24-h after treatment initiation, survival analysis demonstrated a statistically significant relationship (log rank, p = 0.04) between magnesium dosage and recovery period from hypertension. The group receiving 2.0 g/h of magnesium experienced the shortest recovery period from hypertension (6.5 ± 1.8 days). Meanwhile, the other groups required 66.0 ± 26.9 and 48.3 ± 15.6 days to recover after 1.0 and 1.5 g/h of magnesium infusion, respectively. Conclusion: Magnesium sulfate has no impact on GFR improvement during the first 24 h after delivery. However, magnesium maintenance infusion at 2.0 g/h is capable of preventing seizure by optimizing the therapeutic magnesium level (4.8–8.4 mg/dL) and shortening the hypertensive episode in preeclampsia.

Possibility of magnesium supplementation for supportive treatment in patients with COVID-19

“…It has long been known that magnesium deficiency causes an increased incidence of cardiovascular diseases, including hypertension and atherosclerosis ( Saris et al, 2000 ; Seelig, 1994 ). As mentioned above, magnesium has a good effect on hypertension during pregnancy ( Alexander et al, 2006 ; Kreepala et al, 2018 ). Oral magnesium supplementation (300 mg/kg magnesium oxide daily) for 1 month effectively decreases systolic, diastolic and mean arterial blood pressure in patients with essential hypertension at home ( Banjanin and Belojevic, 2018 ).…”

“…Magnesium can inhibit the release of acetylcholine from motor nerve endings, block nerve-muscle conduction, and relax skeletal muscle. Therefore, it effectively controls and prevents preterm labor, gestational hypertension, preeclampsia, and eclampsia with few side effects on the fetus ( Alexander et al, 2006 ; Kreepala et al, 2018 ; Magee and von Dadelszen, 2018 ). Clinically, magnesium sulfate is utilized for fetal neuroprotection in preterm birth ( Bachnas et al, 2019 ; Rouse et al, 2008 ).…”

Assessment of preeclampsia risk by use of serum ionized magnesium-based equation

“…Recent study has shown that the physiological decrease of magnesium during pregnancy is associated with endothelial dysfunction. Which could potentially mark as a factor that leads to preeclampsia [ 19 ]. Several literatures have demonstrated that early preeclampsia can be predicted by biomarkers such as serum placental growth factor (PIGF), soluble fms-like tyrosine kinase 1 and soluble endoglin [ 20–22 ].…”

Furosemida en el control de la hipertensión arterial posparto en preeclámpticas severas

“…La restricción de líquidos en el puerperio, junto con la administración de diuréticos, puede considerarse apropiada en circunstancias específicas. Este tratamiento también puede disminuir el riesgo de alteraciones del sistema nervioso central en preeclámpticas severas durante el puerperio, ya que tanto el edema cerebral como la eclampsia posparto, que están íntimamente relacionados con la perfusión cerebral 23,24 , podrían evitarse con la disminución del líquido intravascular y del tono venoso periférico 25,26 . Los riesgos del tratamiento con diuréticos posparto son escasos y se ha comprobado que disminuyen aún más con el uso de suplemento de potasio oral 21 .…”