title: Maternal side effects & fetal neuroprotection according to body mass index after magnesium sulfate in a multicenter randomized controlled trial.
abstract: OBJECTIVE
  Evidence supports the need of dose-adjustment of several drugs according to body mass index (BMI) to prevent toxicity in the underweight, and ensure efficacy in obese women. However, for MgSO4neuroprotection, the effect of BMI on maternal toxicity and fetal neuroprotection is understudied. We analyze the effect of BMI on maternal/infant outcomes after MgSO4.
  
  
  METHODS
  Secondary analysis of a clinical trial that studied MgSO4neuroprotection. Maternal side effects, magnesium cord levels, and offspring cerebral palsy/death were analyzed along BMI strata using ANOVA and chi-square test. Logistic regression was used to calculate adjusted odds ratios according to the treatment and BMI, using nonobese that received placebo as reference. Interaction analyses were performed to validate differential efficacy of BMI.
  
  
  RESULTS
  From 2241 women, more side effects and higher magnesium cord levels were seen in underweight women (p = 0.05). MgSO4neuroprotection was effective in the non-obese (p = 0.02), but not in obese women (p = 1.00). In multivariate analyses, MgSO4significantly reduced cerebral palsy only in nonobese women. Interaction analyses showed the moderator effect of BMI (p = 0.169). Increasing MgSO4dose in obese mothers may ensure neuroprotective efficacy without representing increased maternal risks. Considering costs of studying this association, current analysis may form the basis for reasonable practice.
authors.affiliation: a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , University of Missouri - Kansas City , Kansas City , MO , USA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Vilchez
authors.affiliation: b Department of Obstetrics & Gynecology , Wayne State University School of Medicine , Detroit , MI , USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Dai
authors.affiliation: c Federico Villareal National University , Lima , Peru.
authors.forename: Moraima
authors.initials: M
authors.lastname: Lagos
authors.affiliation: d Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Wayne State University School of Medicine , Detroit , MI , USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sokol
mesh_terms: D015992:Body Mass Index; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008274:Magnesium / Q000097:blood; D008278:Magnesium Sulfate / Q000009:adverse effects / Q000627:therapeutic use*; D018696:Neuroprotective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D009765:Obesity / Q000453:epidemiology*; D011225:Pre-Eclampsia / Q000188:drug therapy; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012307:Risk Factors
chemical_list: D018696:Neuroprotective Agents; D008278:Magnesium Sulfate; D008274:Magnesium
keywords: Body mass index; cerebral palsy; infant newborn diseases; magnesium sulfate; obstetric labor complications