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Does Magnesium Sulfate Provide Neuroprotection in Preterm Fetuses with Growth Restriction?

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BACKGROUND AND PURPOSE:

  • Recommendations for imminent preterm birth <32 weeks
    • Administration of intrapartum magnesium sulfate for neuroprotection
    • Limited data if beneficial in fetal growth restriction
  • Stockley et al. (AJOG, 2018) sought to determine if there is benefit to magnesium sulfate in the setting of growth restriction at <29 weeks

METHODS:

  • Retrospective cohort study
    • Infants born <29 weeks’ gestation
  • Growth restriction was defined as
    • Estimated fetal weight <10th percentile

or

  • Neonatal birthweight <10th percentile
  • Exposure: Intrapartum magnesium sulfate
    • Administration of magnesium sulfate was at the discretion of the treating physician
  • Primary outcome
    • Composite of death or significant neurodevelopmental impairment at 18–36 months’ corrected age
  • Secondary outcomes
    • Death or any neurodevelopmental impairment at 18–36 months’ corrected age
    • Neonatal morbidities

RESULTS:

  • 336 fetuses with FGR
    • 33% received magnesium sulfate
  • 177 infants with growth restriction,
    • 34% received magnesium sulfate
  • Intrapartum magnesium sulfate was associated with reduced odds of composite of death or significant neurodevelopmental impairment for both fetal and infant definitions
    • Fetal growth restriction: Adjusted odds ratio (OR) 0.42; 95% confidence interval, 0.22–0.80
    • Neonatal standards: adjusted OR 0.44; 95% confidence interval, 0.20–0.98

CONCLUSION:

  • Magnesium sulfate is associated with decreased risk of death or significant neurodevelopmental impairment at 18–36 months’ corrected age in growth restricted fetuses
  • The authors demonstrated risk reduction whether using fetal or neonatal weight standards

Learn More – Primary Sources:

Intrapartum magnesium sulfate is associated with neuroprotection in growth-restricted fetuses

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Related ObG Topics:

MgSO4 and Neuroprotection: What is the Relationship Between Maternal Dose and Fetal Levels?
5 and 10 Minute Apgar Scores: What is Their Relationship with Cerebral Palsy and Epilepsy?
Does Prophylactic rhEPO Improve Brain Development in Preterm Infants?

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