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Magnesium Sulfate for Fetal Neuroprotection in Women at Risk of Preterm Birth: Analysis of its Effect on Cerebral Palsy

Background: Magnesium sulfate (MgSO 4 ) can be used for the primary prevention of cerebral palsy in preterm infants less than 37 weeks of gestational age. Aim and objective: To assess the effect of MgSO 4 given for fetal neuroprotection to women at risk of preterm birth. Materials and Methods: This study was conducted on 100 women admitted to labor room in the Department of Obstetrics and Gynecology, S.N. Medical College, Agra, between August 2018 and December 2020. These women were randomly distributed into two groups. Women taken for study underwent detailed history, examination, and baseline investigations. In group 1, 50 women at risk of preterm birth before 37 weeks (gestational age, 28–36 weeks 6D) of gestation were given MgSO 4 , 4 g bolus over 20–30 minutes followed by 1 g/hour, whereas in group 2, 50 women were not given MgSO 4 . Results: In our study, the majority of the patients were between the gestational age of 31 and 34 weeks. The mean gestational age was 30.1 weeks in group 1 and 31.5 weeks in group 2. The difference in terms of birth weight between the two groups is statistically insignificant. Neonatal outcomes among women administered MgSO 4 and women not administered MgSO 4 include the following: Neonatal seizures (2 vs 4%), respiratory distress (46 vs 60%), mechanical ventilation (48 vs 62%), and neonatal enterocolitis (6 vs 0.5%). The difference between Apgar scores of the two groups is statistically insignificant. Resuscitation was needed, 4 versus 6%, in group 2. There were 1 mortality in group 1 and 2 in group 2. In group 1, 44% of neonates needed neonatal intensive care unit (NICU) admission, whereas in group 2, 62.5% of neonates needed NICU admission with a p value of 0.03095, which is found to be not significant between the two groups. In neonates of group 1, the cases administered MgSO 4 did not show the sign of intraventricular hemorrhage or periventricular leukomalacia, while on the contrary, in neonates of group 2, 4% had ultrasonography suggestive of intraventricular hemorrhage and 6% had periventricular leukomalacia with a p value of 0.14, which is statistically insignificant. Maternal side effects, such as flushing (66 vs 6%), nausea (16 vs 2%), sweating (28 vs 4%), hypotension (2%), tachycardia (4% in group 1), and postpartum hemorrhage, were seen in 4% of women administered MgSO 4 and 2% of cases in group 2. No serious side effects were attributed to MgSO 4 , and the commonest side effect was flushing. Administering MgSO 4 with a large margin of safety in preterm births may help to prevent the development of cerebral palsy in preterm infants. As MgSO 4 is a safe, readily available inexpensive drug even if there are modest benefits for its use, the risk-benefit is in favor of its use. Conclusion: MgSO 4 is the drug currently administered to mothers at the risk of preterm labor for fetal neuroprotection. Further multicenter studies with larger sample sizes exploring immediate adverse outcomes in magnesium-exposed neonates correlated with their serum magnesium concentrations are needed. Further prospective studies must be performed to determine the optimal dose of maternal magnesium for different subgroups of mothers to provide fetal neuroprotection with minimal neonatal adverse outcomes. In the meantime, there is a need for guidelines on the use of MgSO 4 .