Maternal obesity and neuroprotective magnesium sulfate

McPherson, Jessica A.; Smiley, Sarah G.; Stamilio, David M.

doi:10.1016/j.ajog.2015.06.046

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…After screening titles and abstracts, 753 articles were excluded. After assessing the eligibility of the full text of the remaining 15 articles, 10 articles comprising four studies with no necessary data, three reviews, two commentaries, and one study with irrelevant topics were excluded. Finally, five observational studies were included in this study.…”

Section: Resultsmentioning

confidence: 99%

Maternal obesity and risk of cerebral palsy in children: a systematic review and meta‐analysis

Zhang

Peng

Chang

et al. 2018

Develop Med Child Neuro

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Section: Resultsmentioning

confidence: 99%

Maternal obesity and risk of cerebral palsy in children: a systematic review and meta‐analysis

Zhang

Peng

Chang

et al. 2018

Develop Med Child Neuro

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“…However, stratification by BMI class has not been as robust, as the majority of studies typically group all obese subjects into one study group as opposed to the established classes of obesity as done in our study. 14,16,17,19,20 With the increasing incidence of obesity and morbid obesity in our country, evaluating the effect of BMI values over 30 kg/m 2 on standard medical practices and treatments has become more important. 25 Further, our study demonstrates that the effect of increasing BMI holds true regardless of which of the standard loading doses are used.…”

Section: Discussionmentioning

confidence: 99%

“…While several studies have demonstrated lower serum magnesium levels in this population as well, these studies have had mixed results regarding the effect of BMI on the ultimate outcome of cerebral palsy in premature newborns born to subjects receiving magnesium sulfate for this indication. 19,20 Given the known effect of BMI and maternal obesity on serum magnesium levels throughout the intrapartum and postpartum course as well as the effect the initial bolus has on most rapidly reaching therapeutic levels for eclampsia prophylaxis, the goal of our study was to focus our assessment on the effect of BMI, particularly when stratified in an obese population, on the standard intravenous magnesium loading doses used in obstetric practice. We specifically sought to identify the correlation between BMI and Post-Bolus serum magnesium levels for standard loading doses of 4 and 6 g followed by a maintenance dose of 2 g per hour and, consequently, to determine the odds of these magnesium loading doses achieving therapeutic levels for eclamptic seizure prevention as a function of BMI in the obese population.…”

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confidence: 99%

The Effect of Body Mass Index on Post-Bolus Magnesium Levels in the Obstetric Patient

De Zoysa,

Westermann,

Yang

et al. 2023

Am J Perinatol

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Objective In the setting of a growing obese obstetric population, we sought to determine whether differences in body mass index (BMI) and obesity class influenced both serum magnesium levels and the likelihood of achieving therapeutic levels for eclampsia prophylaxis after standard boluses of magnesium sulfate. Study Design This is a retrospective cohort study of patients treated with magnesium sulfate in the setting of either preeclampsia with severe features or preterm labor between 2010 and 2016. Subjects were categorized by BMI: Normal (BMI < 30 kg/m2), Class 1 (BMI 30–34.9 kg/m2), Class 2 (BMI 35–39.9 kg/m2), and Class 3 (BMI ≥ 40 kg/m2). Study participants' demographics, intrapartum characteristics, and adverse reactions were compared among the groups. Logistic regression models were used to calculate unadjusted and adjusted odds ratios comparing the likelihood of each BMI class reaching therapeutic eclamptic prophylactic levels. Linear regression models were also evaluated to determine the relationship between BMI and post-bolus serum magnesium levels. Results Of the 760 people who met the inclusion criteria, 313 (41.1%) had normal BMI, 190 (25.0%) had Class 1 obesity, 135 (17.8%) had Class 2 obesity, and 122 (16.1%) had Class 3 obesity. When adjusted for confounders, those with Class 1 obesity were 54% less likely to achieve serum levels deemed therapeutic for seizure prophylaxis compared with normal BMI counterparts. Meanwhile, those with Class 2 or 3 obesity were 90% less likely. Linear regression models also demonstrated an inverse association between BMI and post-bolus serum magnesium levels. Conclusion Increasing BMI has a significant effect on post-bolus serum magnesium levels regardless of standard loading dose used. Immediately after bolus administration, obese gravidas are significantly less likely to reach levels effective for eclamptic seizure prophylaxis. When considering which bolus to administer in an obese gravida, it may be more beneficial to choose a 6 g load. Key Points

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“…The NICHD MFMU network BEAM trial has been the subject of multiple secondary analyses addressing the relationship of magnesium sulfate dose, duration, or cord blood concentration with neonatal outcomes as it is the largest trial performed to investigate the effect of magnesium sulfate on neurodevelopmental outcomes and neonatal death [21][22][23][24]. Of note was a secondary analysis of the BEAM trial, investigating whether magnesium cord blood concentration and magnesium sulfate infusion at time of delivery are associated with cerebral palsy or death diagnosed by the age of 2 years [25].…”

Section: Discussionmentioning

confidence: 99%

Investigation into the reproducibility of the association of cord blood magnesium concentration and cerebral palsy or death in children

Dixon

Liu

Balch

et al. 2020

Preprint

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Objective: To evaluate the association of cord blood magnesium concentrations at the time of birth with cerebral palsy (CP) and neonatal death. Study Design: A secondary analysis of a randomized controlled trial that randomized women at imminent risk of delivery between 24 and 31 weeks of gestation to receive magnesium sulfate or placebo. This ‘study’s primary outcome was a composite of either moderate to severe CP or death. Secondary outcomes included CP, moderate to severe CP, neonatal death, and neonatal head ultrasound findings. We used a logistic regression model to evaluate the relationship between the concentration of magnesium in cord blood and study outcomes. Results: A total of 668 women were included in this analysis and were randomized to magnesium sulfate at 28 ± 2.5 ‘weeks’ gestation. Cord blood magnesium concentrations were not associated with the primary outcome of infant death by 1 year of age or moderate or severe cerebral palsy, as assessed at or beyond 2 years of age (aOR 0.95 (0.67, 1.36), p = 0.79). Cord blood magnesium concentrations were not associated with any of the secondary outcome measurements. Conclusion: Cord blood magnesium concentrations were not associated with moderate to severe cerebral palsy or death, or other neurodevelopmental or sonographic outcomes.

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Maternal obesity and neuroprotective magnesium sulfate

Cited by 7 publications

References 10 publications

Maternal obesity and risk of cerebral palsy in children: a systematic review and meta‐analysis

Maternal obesity and risk of cerebral palsy in children: a systematic review and meta‐analysis

The Effect of Body Mass Index on Post-Bolus Magnesium Levels in the Obstetric Patient

Investigation into the reproducibility of the association of cord blood magnesium concentration and cerebral palsy or death in children

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