Maternal receipt of magnesium sulfate does not seem to reduce the risk of neonatal white matter damage.
OBJECTIVE
To investigate whether in utero exposure to magnesium sulfate is associated with a lower incidence of cranial ultrasonographic abnormalities that predict cerebral palsy in infants who weigh less than 1501 g at birth.


METHODS
For a prospective study of the antecedents of cranial ultrasonographic abnormalities, we enrolled infants who weighed 500 to 1500 g when born at five institutions. Data were collected by interview of the mothers and review of medical records. Protocol cranial ultrasonograms were obtained as close as possible to postnatal days 1, 7, and 21. Abnormality on cranial ultrasound scans was determined by a consensus committee of three sonologists.


RESULTS
Of the 1518 infants for whom we knew whether the mothers received magnesium sulfate, the first protocol cranial ultrasound scan was available for 1409 infants, the second for 1274 infants, and the third for 1050 infants. Forty-five percent of infants were exposed to magnesium sulfate before delivery. The major correlates of magnesium sulfate exposure were receipt of antenatal corticosteroids and a diagnosis of preeclampsia and/or pregnancy-induced hypertension. Maternal magnesium receipt was not associated with a reduced incidence of hypoechoic or hyperechoic images of white matter parenchyma, intraventricular hemorrhage, or ventriculomegaly, even when the sample was stratified by each of six potential confounders. When adjustment was made for gestational age, a measure of birth weight for gestational age, antenatal corticosteroid exposure, preeclampsia and pregnancy-induced hypertension, route of delivery, and the occurrence of any labor, the risk ratios for each cranial ultrasonographic abnormality associated with magnesium sulfate exposure hovered close to 1.


CONCLUSIONS
Maternal receipt of magnesium sulfate does not seem to be associated with an appreciably reduced risk of cranial ultrasonographically defined neonatal white matter damage, intraventricular hemorrhage, or ventriculomegaly.
Leviton
A
A
Children's Hospital, Boston, Massachusetts, USA.
Paneth
N
N
Susser
M
M
Reuss
M L
ML
Allred
E N
EN
Kuban
K
K
Sanocka
U
U
Hegyi
T
T
Hiatt
M
M
Shahrivar
F
F
Van Marter
L J
LJ
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging; D002547:Cerebral Palsy / Q000000981:diagnostic imaging; D015986:Confounding Factors, Epidemiologic; D004453:Echoencephalography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007969:Leukomalacia, Periventricular / Q000000981:diagnostic imaging; D016015:Logistic Models; D008278:Magnesium Sulfate / Q000494:pharmacology / Q000627:therapeutic use*; D016017:Odds Ratio; D011225:Pre-Eclampsia / Q000188:drug therapy; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy; D011446:Prospective Studies
D000305:Adrenal Cortex Hormones; D008278:Magnesium Sulfate