Magnesium Sulfate administration prior to preterm birth fails to increase child survival without cerebral palsy

The trial enrolled 1433 pregnant individuals with a mean age of 30.6 years, including a diverse range of ethnic backgrounds. Among their 1679 infants, 1365 were included in the primary outcome analysis. The primary outcome assessed was the occurrence of death (including stillbirth, infant death before or after hospital discharge) or cerebral palsy at 2 years of corrected age.

• The study found that the administration of intravenous magnesium sulfate did not result in a significant difference in the occurrence of death or cerebral palsy between the magnesium group and the placebo group.
• The rates were 3.3% for the magnesium group and 2.7% for the placebo group. The adjusted relative risk was 1.19 (95% CI, 0.65 to 2.18), and the risk difference was 0.61% (95% CI, -1.27% to 2.50%).
• The study also examined various secondary outcomes related to the health of pregnant individuals, infants, and children. Neonates in the magnesium group demonstrated lower rates of respiratory distress syndrome (34% vs 41%) and chronic lung disease (5.6% vs 8.2%) compared to the placebo group during their hospital stay after birth.
• It's important to note that while no serious adverse events occurred, adverse events were more likely in pregnant individuals who received magnesium compared to the placebo group. Adverse events occurred in 77% of those who received magnesium and 20% of those who received the placebo.
• While fewer pregnant individuals in the magnesium group underwent cesarean deliveries (56% vs 61%), more in the magnesium group experienced major postpartum haemorrhage (3.4% vs 1.7%).

The study concludes that the administration of intravenous magnesium sulfate prior to preterm birth at 30 to 34 weeks' gestation did not significantly improve child survival without cerebral palsy at 2 years. However, the researchers acknowledge that the study's power might have been limited in detecting small differences between the groups.

This study contributes valuable insights into the potential effects of magnesium sulfate on preterm births and highlights the complexity of managing interventions in this context. Further research may be needed to refine and better understand the impacts of such treatments on child health outcomes.

Reference:

Crowther, C. A., Ashwood, P., Middleton, P. F., McPhee, A., Tran, T., Harding, J. E., Alsweiler, J., Baker, E., Eaglen, D., Groom, K., Hauch, H., Mackay, L., Pacella, M. J., Preest, A., Taylor, J., Williamson, K., Tottman, A., Austin, N., Darlow, B. A., … MAGENTA Study Group. (2023). Prenatal intravenous magnesium at 30-34 weeks’ gestation and neurodevelopmental outcomes in offspring: The MAGENTA randomized clinical trial. JAMA: The Journal of the American Medical Association, 330(7), 603. https://doi.org/10.1001/jama.2023.12357