A systematic review of maternal and infant outcomes following magnesium sulfate for pre-eclampsia/eclampsia in real-world use.
BACKGROUND
Evidence from RCTs shows that magnesium sulfate reduces the risk of seizures and mortality for women with pre-eclampsia/eclampsia. However, it has been argued that outcomes within trials may not reflect real-world outcomes with the same intervention.


OBJECTIVE
To assess whether outcomes for women with pre-eclampsia/eclampsia who received magnesium sulfate in the real world were comparable to those in RCTs.


METHODS
EMBASE and MEDLINE were searched (January 1990-July 2010).


METHODS
Cohort, before-and-after, and serial cross-sectional studies were included. Participants were women with eclampsia who received magnesium sulfate or another anticonvulsant, and women with pre-eclampsia who received magnesium sulfate or no anticonvulsant. Primary outcomes were death (maternal, fetal, neonatal) or recurrent seizures.


METHODS
Data were extracted independently by 2 reviewers.


RESULTS
Six studies (1831 women with eclampsia) were included, from academic centers in Bangladesh, India, Pakistan, and Nigeria, together with 2 population-based UK studies. Magnesium sulfate for eclampsia was associated with lower risks of maternal death, recurrent seizure, and major morbidity; for pre-eclampsia, it was associated with lower risks of eclampsia.


CONCLUSIONS
Improvements in maternal outcome with magnesium sulfate for pre-eclampsia/eclampsia in real-world use are comparable to those reported in RCTs.
Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada. mcdonals@mcmaster.ca
Sarah D
SD
McDonald
Olha
O
Lutsiv
Nancy
N
Dzaja
Lelia
L
Duley
D000927:Anticonvulsants / Q000627:therapeutic use*; D004461:Eclampsia / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D011225:Pre-Eclampsia / Q000188:drug therapy*; D011247:Pregnancy; D012640:Seizures / Q000517:prevention & control
D000927:Anticonvulsants; D008278:Magnesium Sulfate