Magnesium Sulfate Reduces Cerebral Palsy Risk in Preterm Births, Study Confirms

The review provided an evidence assessment through six RCTs that included 5,917 pregnant participants with 6,759 fetuses who were at risk of preterm birth and had all been randomized prior to reaching 34 weeks of gestation. These trials were conducted in various high-income countries including the US, Australia, New Zealand, Denmark, and France, between 1995 and 2018. The authors explored databases like Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform to study the efficacy and safety of magnesium sulfate as a fetal neuroprotective agent.

It included only RCTs that compared magnesium sulfate with a placebo for neuroprotection in preterm births. The studies for inclusion were independently assessed by two authors, ensuring integrity of data extraction, and the risk of bias was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.

There were several key benefits and risks associated with magnesium sulfate use in preterm births:

• Magnesium sulfate significantly lowered the rate of cerebral palsy up to 2 years of corrected age, with a RR of 0.71 (95% CI, 0.57–0.89), in six RCTs that included a total of 6,107 children. The evidence for this is of high certainty and supports its administration as a neuroprotective treatment in preterm infants.

• Besides cerebral palsy rates, magnesium sulfate resulted in a decrease in children regarding the combined risks of death or cerebral palsy. It constitutes RR 0.87, 95% Confidence Interval, 0.77–0.98 and is based on six RCTs with a total of 6,481 children. Further, it has underlined that the medication has proved highly effective in improving neonatal outcomes for the preterm infants.

• Although magnesium sulfate reduced neurological impairments, it had small or no effect on the combined total mortality up to 2 years of corrected age (moderate-certainty evidence). It had small or no effects on mortality rates or neurological outcomes measured at school age (low-certainty evidence).

• Magnesium sulfate was associated with a higher risk of adverse effects that were serious enough to require stopping treatment (RR 3.21, 95% CI, 1.88–5.48; based on three RCTs reporting data for 4,736 participants). The side effects also underline the importance of weighing up benefits and risks of the treatment.

• Another important benefit associated with magnesium sulfate was in reducing the risk of severe neonatal intraventricular hemorrhage, a complication in very preterm infants (moderate-certainty evidence).

The use of magnesium sulfate in preterm births has significant neuroprotective benefits, most specifically for reducing the risk of cerebral palsy and death or cerebral palsy of preterm infants. Treatment is promising in preventing severe neurological impairments; however, more research is needed regarding long-term outcomes and generalizing findings across populations. Future trials should also ensure the optimization of dosage and the identification of which patient group would benefit from the use of magnesium sulfate treatment.

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