An overview of the possible relationship between antenatal pharmacologic magnesium and cerebral palsy.
Magnesium sulfate is currently being used in obstetric practice for either eclamptic seizure prophylaxis or for tocolysis, in some countries. Evidence for its use in preeclampsia is credible, whereas the evidence for its use as a tocolytic is limited, if not absent. Of interest, the findings of two epidemiologic studies have suggested a third possible use for antenatal pharmacologic magnesium sulfate, namely, as a neuroprotectant against the later development of cerebral palsy in the newborn. In support of this hypothesis are laboratory data, much of which have to do with the modulation of cellular membrane receptors. Unfortunately, during the Magnesium and Neurologic Endpoints Trial (MagNET), while attempting to confirm the neuroprotective effect of magnesium sulfate, the occurrence of excess total pediatric mortality in those children exposed to magnesium led to early termination of the trial. Nonetheless, despite the alarming findings in MagNET, it is conceivable that exposures to doses of magnesium sulfate less than those often used for aggressive tocolysis may be neuroprotective without being lethal. Other randomized controlled trials now underway may answer this important question.
Mittendorf
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Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, IL, USA. robert@babies.bsd.uchicago.edu
Pryde
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PG
D002547:Cerebral Palsy / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008278:Magnesium Sulfate / Q000008:administration & dosage / Q000627:therapeutic use*; D011225:Pre-Eclampsia / Q000188:drug therapy; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D016194:Receptors, N-Methyl-D-Aspartate / Q000187:drug effects / Q000502:physiology; D015145:Tocolysis
D016194:Receptors, N-Methyl-D-Aspartate; D008278:Magnesium Sulfate