#Grand Rounds

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

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

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

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

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

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