Association between the use of antenatal magnesium sulfate in preterm labor and adverse health outcomes in infants.
OBJECTIVE
The purpose of this study was to determine whether the use of antenatal magnesium sulfate prevents adverse outcomes (neonatal intraventricular hemorrhage, periventricular leucomalacia, death, and cerebral palsy).


METHODS
In a controlled trial, we randomized mothers in preterm labor to magnesium sulfate, "other" tocolytic, or placebo. At delivery, umbilical cord blood was collected for the later determination of serum ionized magnesium levels. Neonatal cranial ultrasound scans were obtained periodically for the diagnosis of intraventricular hemorrhage and periventricular leucomalacia. Among survivors, the diagnosis of cerebral palsy was made at age 18 months.


RESULTS
Children with adverse outcomes had higher umbilical cord magnesium levels at delivery. In regression models that controlled for confounders, which included very low birth weight, magnesium remained a significant risk factor (adjusted odds ratio, 3.7; 95% CI, 1.1-11.9; P =.03).


CONCLUSIONS
Contrary to original hypotheses, this randomized trial found that the use of antenatal magnesium sulfate was associated with worse, not better, perinatal outcome in a dose-response fashion.
Mittendorf
Robert
R
Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, IL 60153, USA. rmitten@lumc.edu
Dambrosia
James
J
Pryde
Peter G
PG
Lee
Kwang-Sun
KS
Gianopoulos
John G
JG
Besinger
Richard E
RE
Tomich
Paul G
PG
D000328:Adult; D002543:Cerebral Hemorrhage / Q000139:chemically induced*; D002547:Cerebral Palsy / Q000139:chemically induced*; D005260:Female; D005312:Fetal Blood; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007743:Labor, Obstetric; D007969:Leukomalacia, Periventricular / Q000139:chemically induced*; D008274:Magnesium / Q000097:blood; D008278:Magnesium Sulfate / Q000009:adverse effects* / Q000627:therapeutic use; D007752:Obstetric Labor, Premature / Q000188:drug therapy*; D011247:Pregnancy; D011295:Prenatal Care; D012307:Risk Factors; D015149:Tocolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use
D015149:Tocolytic Agents; D008278:Magnesium Sulfate; D008274:Magnesium