Brain lesions in newborns exposed to high-dose magnesium sulfate during preterm labor.
High-dosage, tocolytic magnesium sulfate (MgSO4) administered to pregnant women during preterm labor can be toxic, and sometimes lethal, for their newborns (Cochrane Database of Systematic Reviews (relative mortality risk 2.82, 95% confidence interval 1.2-6.6)). Based on the results of the Magnesium and Neurologic Endpoints Trial and the work of many others, a unifying triangular concept is proposed to account for the increased prevalence of brain lesions, with their likely resultant mortality, in neonates and infants exposed to high-dose MgSO4 in the context of preterm labor. We review the evidence that: (1) elevated circulating levels of serum ionized magnesium occurring in mothers, and therefore in their babies, at the time of delivery are associated with subsequent neonatal intraventricular hemorrhage (IVH); (2) neonatal IVH is strongly associated with lenticulostriate vasculopathy (LSV), an unusual mineralizing lesion involving the thalami and basal ganglia of the neonate; and, (3) exposure to 50 g or more of tocolytic MgSO4 during preterm labor is associated with the development of LSV.
Mittendorf
R
R
Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, IL 60153, and Neuroepidemiology Unit, Children's Hospital, Harvard Medical School, Boston, MA, USA. rmitten@lumc.edu
Dammann
O
O
Lee
K-S
KS
D020144:Basal Ganglia Cerebrovascular Disease / Q000139:chemically induced* / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D002547:Cerebral Palsy / Q000517:prevention & control; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008278:Magnesium Sulfate / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D007752:Obstetric Labor, Premature / Q000188:drug therapy / Q000517:prevention & control; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic / Q000009:adverse effects / Q000401:mortality; D015149:Tocolytic Agents / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use
D015149:Tocolytic Agents; D008278:Magnesium Sulfate