Magnesium Sulphate May Reduce Cerebral Palsy

Tag : magnesium

Giving magnesium sulphate to stop women from going into prematurelabour could reduce the chances of babies later being diagnosedwith moderate to severe cerebral palsy, said researchers in the US.

The multicenter, placebo-controlled, double-blind trial was thework of Dr Dwight Rouse, from the University of Alabama atBirmingham, and colleagues, and is published in the 28 Augustonline issue of the New England Journal of Medicine, NEJM .

For the research, Rouse and colleagues studied 2,241 women who wereat risk of going into premature labour between their 24th and 31stweek of pregnancy. The women were randomly assigned to receiveeither magnesium sulphate, given intravenously as a 6g bolusfollowed by a constant infusion of 2g per hour, or a matchingplacebo.

Magnesium sulphate is used to slow down the contractions of theuterus and thereby delay labour.

The researchers followed the surviving babies for two years. Theycounted the number of stillbirths or babies that died beforereaching 1 year of corrected age, and they also counted theincidence of moderate or severe cerebral palsy at or beyond 2 yearsof corrected age.

The results showed that: 95.6 per cent of the children were followed up.
Primary analysis did not show significant differences between thetwo groups in the combined risk of moderate or severe palsy ordeath (11.3 per cent in the treatment group, 11.7 per cent in theplacebo group, with a relative risk of 0.97).
Secondary analysis showed that moderate or severe cerebral palsyoccurred significantly less frequently in the magnesium sulfategroup (1.9 per cent versus 3.5 per cent more cases in the placebogroup, giving a relative risk of 0.55, ie 45 per cent less risk ofmoderate or severe cerebral palsy in the treatment group).
The risk of death was not significantly different between thegroups.
Adverse events such as flushing and sweating were more common amongthe women in the treatment group, and none of the women experienceda life-threatening event. The authors concluded that:

"Fetal exposure to magnesium sulfate before anticipated earlypreterm delivery did not reduce the combined risk of moderate orsevere cerebral palsy or death, although the rate of cerebral palsywas reduced among survivors."

An editorial in the same issue of the journal said the study showedpromising results but did not recommend using magnesium sulphate inanticipated preterm labour as a way to prevent cerebral palsy.

The editors, who included Dr Fiona Stanley, from the University ofWestern Australia's Centre for Child Health Research, said thatmore research was needed that looked more closely at the reasonsfor preterm birth and the effects of timing (eg relative topregnancy weeks and birth) and size of magnesium sulphate doses.

"A Randomized, Controlled Trial of Magnesium Sulfate for thePrevention of Cerebral Palsy."
Rouse, Dwight J., Hirtz, Deborah G., Thom, Elizabeth, Varner,Michael W., Spong, Catherine Y., Mercer, Brian M., Iams, Jay D.,Wapner, Ronald J., Sorokin, Yoram, Alexander, James M., Harper,Margaret, Thorp, John M., Jr., Ramin, Susan M., Malone, Fergal D.,Carpenter, Marshall, Miodovnik, Menachem, Moawad, Atef, O'Sullivan,Mary J., Peaceman, Alan M., Hankins, Gary D.V., Langer, Oded,Caritis, Steve N., Roberts, James M., the Eunice Kennedy ShriverNICHD Maternal-Fetal Medicine Units Network.
N Engl J Med 2008, 359: 895-905.
Volume 359; pages 895-905, published online August 28, 2008.

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Sources: NEJM .

Written by: Catharine Paddock, PhD
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