Association between maternal serum ionized magnesium levels at delivery and neonatal intraventricular hemorrhage.
OBJECTIVE
To determine whether magnesium sulfate (MgSO(4)) exposure is associated with a reduced risk for neonatal intraventricular hemorrhage (IVH).


METHODS
In a randomized, controlled trial, women in preterm labor were randomly assigned to receive MgSO(4), "other" tocolytic, or saline control. At delivery, we collected maternal antecubital and umbilical cord blood for determination of serum ionized magnesium levels. Neonatal IVH was diagnosed by cranial ultrasonogram.


RESULTS
Among 144 infants, 24 were diagnosed with IVH. Using crude intention-to-treat analysis, we found that 18% (13/74) of survivors exposed after birth to MgSO(4) had IVH compared with 16% (11/70) of babies who were not exposed. Infants who had IVH were more likely to have been delivered by mothers with higher serum ionized magnesium (Mg) levels (0.75 vs 0.56 mmol/L) (P =.01). Using multivariable logistic regression, we confirmed that higher Mg levels are a significant predictor of neonatal IVH (adjusted odds ratio, 15.8; 95% CI, 1.4-175.0) even when adjusted for birth weight, gestational age, antenatal hemorrhage, and neonatal glucocorticoid exposure.


CONCLUSIONS
In mothers with preterm labor, our data indicate that antenatal MgSO(4) exposure may be associated with an increased risk for IVH among their newborns.
Mittendorf
Robert
R
Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Dambrosia
James
J
Dammann
Olaf
O
Pryde
Peter G
PG
Lee
Kwang-Sun
KS
Ben-Ami
Tamar E
TE
Yousefzadeh
David
D
D000328:Adult; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008278:Magnesium Sulfate / Q000009:adverse effects* / Q000097:blood; D015999:Multivariate Analysis; D007752:Obstetric Labor, Premature / Q000188:drug therapy*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D012306:Risk; D015149:Tocolytic Agents / Q000009:adverse effects* / Q000097:blood; D014463:Ultrasonography; D014481:United States / Q000453:epidemiology
D015149:Tocolytic Agents; D008278:Magnesium Sulfate