Proximity of magnesium exposure to delivery and neonatal outcomes.

Abstract

BACKGROUND:

In infants delivered preterm, magnesium sulfate reduces cerebral palsy in survivors. The benefit of magnesium given remote from delivery is unclear.

OBJECTIVE:

Our objective was to evaluate the association of time from last exposure to magnesium with cerebral palsy.

STUDY DESIGN:

This was a secondary analysis of a multicenter trial evaluating magnesium for neuroprotection. For this study, we included women with live, nonanomalous, singleton gestations who received magnesium. Pregnancies with missing information at the 2 year follow-up were excluded. Women were divided into 2 groups based on exposure timing: last infusion of magnesium <12 hours and last infusion of magnesium ≥12 hours prior to delivery. The primary outcome was cerebral palsy of any severity at 2 years of life. Secondary outcomes were moderate/severe cerebral palsy and moderate/severe cerebral palsy or death. A χ(2) test, Student t test, and Mann-Whitney U test were used for bivariate associations. We fit a multivariable logistic regression model to adjust for confounders.

RESULTS:

A total of 906 infants were analyzed. Five hundred sixty-eight were last exposed to magnesium <12 hours prior to delivery and 338 were last exposed ≥12 hours. Cerebral palsy occurred in 28 offspring (3%), 2.3% of those last exposed <12 hours vs 4.4% last exposed ≥12 hours prior to delivery (P = .07). On adjusted analyses, last exposure to magnesium <12 hours prior to delivery was associated with a significant reduction in cerebral palsy compared with last exposure ≥12 hours (adjusted odds ratio, 0.41, 95% confidence interval, 0.18-0.91, P = .03). There was no difference in secondary outcomes.

CONCLUSION:

Exposure to magnesium proximal to delivery (<12 hours) is associated with a reduced odds of cerebral palsy compared with more remote exposure. This highlights the importance of the timing of magnesium for neuroprotection for women at risk of preterm delivery.

• Authors: Amy L Turitz, Gloria T Too, Cynthia Gyamfi-Bannerman
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 215 Issue 4 Pg. 508.e1-6 (Oct 2016) ISSN: 1097-6868 [Electronic] United States
• PMID: 27177525 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Chemical References

• Placebos
• Magnesium Sulfate

Topics

• Adult
• Cerebral Palsy (prevention & control)
• Delivery, Obstetric
• Female
• Humans
• Infant, Newborn
• Magnesium Sulfate (therapeutic use)
• Obstetric Labor, Premature
• Odds Ratio
• Placebos
• Pregnancy
• Premature Birth
• Risk Factors
• Time Factors