title: Antenatal magnesium sulfate for both tocolysis and fetal neuroprotection in premature rupture of the membranes before 32 weeks' gestation.
abstract: OBJECTIVE
  We aimed to assess the impact of antenatal MgSO4therapy given to women with PPROM before 32 weeks' gestation on latency, maternal outcomes, perinatal outcomes, and neurodevelopmental outcomes.
  
  
  METHODS
  We undertook a retrospective cohort observational study of 184 singleton pregnancies complicated by PPROM at 23°-316weeks who were hospitalized and received magnesium therapy for tocolysis (MgSO4group) or did not receive tocolytic therapy (no MgSO4group) between 2005 and 2013. Furthermore, patients were subdivided into two groups based on the gestational age at the onset of PPROM (23°-276weeks' gestation and 28°-316weeks' gestation).
  
  
  RESULTS
  We included 184 women, of whom 143 received magnesium therapy and 41 did not. The latency period was significantly longer in the MgSO4group compared with no MgSO4group (7.9 ± 9.0 versus 4.0 ± 6.0 days, p = .0017). Antenatal magnesium therapy was significantly associated with decreased stillbirth (1.4% versus 14.6%, p = .0012) and perinatal mortality (7% versus 19.5%, p = .0375) without significant increase in the risk of neonatal morbidities and chorioamnionitis. However, neonates who were exposed to antenatal MgSO4were associated with higher Mg levels (3.63 ± 1.05 mg/dl versus 2.13 ± 0.48 mg/dl, p < .0001) and phosphate levels (6.90 ± 1.36 mg/d versus 6.40 ± 1.01 mg/dl, p = .0459) than those who were not exposed. Neonates who were exposed to MgSO4showed significantly reduced risks of IVH (20.4% versus 58.3%; RR, 0.35; 95%CI, 0.17-0.71) and PVL (27.8% versus 58.3%; RR, 0.48; 95%CI, 0.25-0.91) in the subgroup of 23°-276weeks' gestation. And the incidence of developmental delay in the subgroup of 23°-276weeks' gestation was significantly lower in the MgSO4group (6.5% versus 36.4%; RR, 0.18; 95%CI, 0.05-0.69). However, there were no significant differences in the development of IVH, PVL, and developmental delay between the two groups for patients in the subgroup of 28°-316weeks' gestation. A similar trend was observed for cerebral palsy, with 22.2% of unexposed children affected compared with only 7.0% of exposed children (RR, 0.31; 95%CI, 0.10-1.00).
  
  
  CONCLUSIONS
  Antenatal magnesium therapy in women with PPROM before 32 weeks' gestation could prolong latency period, allowing for corticosteroid benefit. Moreover, MgSO4showed fetal neuroprotective effects for neonatal IVH and PVL, and for developmental delay in infancy while prolonging latency. However, these benefits were primarily limited to the subgroup of 23°-276weeks' gestation and prolonged in utero exposure to MgSO4was associated with bone mineralization in the neonates.
authors.affiliation: a Department of Obstetrics and Gynecology , Busan Paik Hospital, Inje University , Busan , South Korea.
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Jung
authors.affiliation: a Department of Obstetrics and Gynecology , Busan Paik Hospital, Inje University , Busan , South Korea.|b Paik Institute for Clinical Research , Busan Paik Hospital, Inje University , Busan , South Korea.
authors.forename: Jung Mi
authors.initials: JM
authors.lastname: Byun
authors.affiliation: a Department of Obstetrics and Gynecology , Busan Paik Hospital, Inje University , Busan , South Korea.|b Paik Institute for Clinical Research , Busan Paik Hospital, Inje University , Busan , South Korea.
authors.forename: Young Nam
authors.initials: YN
authors.lastname: Kim
authors.affiliation: a Department of Obstetrics and Gynecology , Busan Paik Hospital, Inje University , Busan , South Korea.|b Paik Institute for Clinical Research , Busan Paik Hospital, Inje University , Busan , South Korea.
authors.forename: Kyung Bok
authors.initials: KB
authors.lastname: Lee
authors.affiliation: a Department of Obstetrics and Gynecology , Busan Paik Hospital, Inje University , Busan , South Korea.|b Paik Institute for Clinical Research , Busan Paik Hospital, Inje University , Busan , South Korea.
authors.forename: Moon Su
authors.initials: MS
authors.lastname: Sung
authors.affiliation: a Department of Obstetrics and Gynecology , Busan Paik Hospital, Inje University , Busan , South Korea.|b Paik Institute for Clinical Research , Busan Paik Hospital, Inje University , Busan , South Korea.
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Kim
authors.affiliation: c Department of Pediatrics , Busan Paik Hospital, Inje University , Busan , South Korea.
authors.forename: Jong Beom
authors.initials: JB
authors.lastname: Shin
authors.affiliation: a Department of Obstetrics and Gynecology , Busan Paik Hospital, Inje University , Busan , South Korea.|b Paik Institute for Clinical Research , Busan Paik Hospital, Inje University , Busan , South Korea.
authors.forename: Dae Hoon
authors.initials: DH
authors.lastname: Jeong
mesh_terms: D000328:Adult; D002113:Calcification, Physiologic / Q000187:drug effects; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D006801:Humans; D007231:Infant, Newborn; D008278:Magnesium Sulfate / Q000494:pharmacology / Q000627:therapeutic use*; D065886:Neurodevelopmental Disorders / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D015149:Tocolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D015149:Tocolytic Agents; D008278:Magnesium Sulfate
keywords: Magnesium sulfate; neuroprotection; preterm premature rupture of the membranes; tocolysis