title: Effect of magnesium sulfate and nifedipine on the risk of developing pulmonary edema in preterm births.
abstract: OBJECTIVE
  To evaluate the risk of developing pulmonary edema in women exposed to nifedipine, magnesium sulfate (MgSO4), or both in a preterm setting.
  
  
  METHODS
  We carried out a retrospective case-control study at a large tertiary care center from 2007 to 2012. Cases of pulmonary edema were age, and gestational age matched to controls at a ratio of 1 case to 4 controls. Logistic regression analysis was used to estimate the effect of nifedipine and/or MgSO4 on the development of pulmonary edema while controlling for predetermined confounding variables. Stepwise logistic regression analysis was used to evaluate additional risk factors of pulmonary edema.
  
  
  RESULTS
  A total of 150 charts were reviewed (28 cases and 122 controls). Nifedipine did not increase the odds of developing pulmonary edema [adjusted odds ratio (OR)=1.22 (confidence interval (CI) 0.50, 3.01), P=0.67], whereas exposure to MgSO4, or both MgSO4 and nifedipine, significantly increased the risk of developing pulmonary edema [adjusted OR=3.91 (CI 1.44, 10.65), P=0.008 and adjusted OR=4.75 (CI 1.15, 19.71), P=0.032, respectively]. In the stratified analysis, this association persisted even in nonpreeclamptic women [nifedipine: adjusted OR=0.91 (CI 0.33, 2.52), P=0.852; MgSO4: adjusted OR=3.51 (CI 1.26, 9.76), P=0.016; both: adjusted OR=3.39 (0.76, 15.07), P=0.108]. Other independent risk factors for pulmonary edema were multi-fetal pregnancy, azithromycin, and erythromycin administration.
  
  
  CONCLUSIONS
  MgSO4 treatment is strongly associated with the development of pulmonary edema when used either as a tocolytic agent or for seizure prophylaxis. In light of the availability of safer alternatives, MgSO4 should be used for tocolysis only in cases whereby the benefits clearly outweigh the risks.
authors.forename: ChengWei
authors.initials: C
authors.lastname: Xiao
authors.forename: Mihnea
authors.initials: M
authors.lastname: Gangal
authors.forename: Haim A
authors.initials: HA
authors.lastname: Abenhaim
mesh_terms: D000328:Adult; D017963:Azithromycin / Q000008:administration & dosage / Q000009:adverse effects; D016022:Case-Control Studies; D004357:Drug Synergism; D004917:Erythromycin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008278:Magnesium Sulfate / Q000008:administration & dosage / Q000009:adverse effects*; D009543:Nifedipine / Q000008:administration & dosage / Q000009:adverse effects*; D007752:Obstetric Labor, Premature / Q000188:drug therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D011272:Pregnancy, Multiple; D047928:Premature Birth / Q000517:prevention & control; D011654:Pulmonary Edema / Q000150:complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015145:Tocolysis; D015149:Tocolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D015149:Tocolytic Agents; D004917:Erythromycin; D008278:Magnesium Sulfate; D017963:Azithromycin; D009543:Nifedipine