Export file:

Format

  • RIS(for EndNote,Reference Manager,ProCite)
  • BibTex
  • Text

Content

  • Citation Only
  • Citation and Abstract

Risks and Benefits of Magnesium Sulfate Tocolysis in Preterm Labor (PTL)

1 Banner University Medical Center, Phoenix, 1111 East McDowell Road, Phoenix, AZ 85005
2 Department of Obstetrics and Gynecology, University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi, 39216

The U.S. Food and Drug Administration issued a drug safety communication on 05/30/2013 recommending “against prolonged use of magnesium sulfate to stop preterm labor (PTL) due to bone changes in exposed babies.” In September of 2013, The American Congress of Obstetrics and Gynecologists issued Committee Opinion No. 573 “ Magnesium Sulfate Use in Obstetrics” , which supports the short term use of MgSO4 to prolong pregnancy (up to 48 hrs.) to allow for the administration of antenatal corticosteroids.” Are these pronouncements by respected organizations short sighted and will potentially result in more harm than good? The FDA safety communication focuses on bone demineralization (a few cases with fractures) with prolonged administration of MgSO4 (beyond 5–7 days). It cites 18 case reports in the Adverse Event Reporting System with an average duration of magnesium exposure of 9.6 weeks (range 8–12 wks). Other epidemiologic studies showed transient changes in bone density which resolved in the short duration of follow up. Interestingly, the report fails to acknowledge the fact that these 18 fetuses were in danger of PTD and the pregnancy was prolonged by 9.6 weeks (e.g. extending 25 weeks to 34.6 wks), thus significantly reducing mortality and morbidity. Evidence does support the efficacy of MgSO4 as a tocolytic medication. The decision to use magnesium, the dosage to administer, the duration of use, and alternative therapies are physician judgments. These decisions should be made based on a reasonable assessment of the risks of the clinical situation (PTL) and the treatments available versus the benefits of significantly prolonging pregnancy.
  Figure/Table
  Supplementary
  Article Metrics

References

1. ACOG Practice Bulletin No. 127 Management of Preterm Labor. June 2012.

2. U.S. Food and Drug Administration Drug Safety Communication. FDA recommends against prolonged use of magnesium sulfate to stop pre-term labor due to bone changes in exposed babies. 05/30/2013.

3. ACOG Committee Opinion, No. 573. (2013) Magnesium Sulfate Use in Obstetrics. Obstet Gynecol 122: 727-8.

4. Vintzileos, AM. (2009) Evidence-Based Compared With Reality-Based Medicine in Obstetrics. Obstet Gynecol 113: 1335-40.

5. Evidence-Based Medicine Working Group. (1992) Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine. JAMA 268:2420-5.    

6. Sackett, DL. (1997) Evidence-Based Medicine. Seminar Perinatol 21: 3-5.    

7. Steer CM, Petrie, RH. (1977) A comparison of magnesium sulfate and alcohol for the prevention of premature labor. Am J Obstet Gynecol 29: 1-4.

8. Elliott JP. (1983) Magnesium sulfate as a tocolytic agent. Am J Obstet Gynecol 147: 277-84.    

9. Elliott JP, Lewis DF, Morrison JC. (2009) In Defense of Magnesium Sulfate. Obstet Gynecol 113: 1341-7.

10. Ma L. (1992) Magnesium sulfate in the prevention of preterm labor (translation). Chung Hua I Hsveh Chin Taipla 72: 158-61.

11. Fox MD, Allbert JR, McCaul JF, Martin RW, McLaughlin BN, Morrison JC. (1993) Neonatal morbidity between 34 and 37 weeks gestation. J Perinatol XIII: 349-53.

12. Cox SM, Sherman ML, Leveno KJ. (1990) Randomized investigation of magnesium sulfate for prevention of preterm birth. Am J Obstet Gynecol 163 (3): 568-72.

13. Elliott JP. (1990) Letter to the editor- Sub therapeutic doses of magnesium sulfate do not inhibit preterm labor. Am J Obstet Gynecol 163: 568.

14. Mercer BM and Merlino AA. (2009) Magnesium Sulfate Preterm Labor and Preterm Birth. Am J Obstet Gynecol 114: 650-66.

15. Hung J, Tsai M, Yang B. (2005) Maternal Osteoporosis After Prolonged Magnesium Sulfate Tocolysis therapy: A Case Report. Arch Phys Med Rehabil 86: 146-9.    

16. Conde-Agudelo A, Romero R. (2009) Antenatal magnesium sulfate for the prevention of cerebral palsy in preterm infants less than 34 weeks gestation. Am J Obstet Gynecol 200: 595-609.    

17. ACOG Committee Opinion No. 455. Magnesium sulfate before anticipated preterm birth for neuroprotection. March 2010.

18. Scott JR. (2009) Magnesium Sulfate for neuroprotection. What do we do now? Obstet Gynecol 114: 500-01.

19. Reeves SA, Gibbs RS, and Clark SL. (2011) Magnesium for fetal neuroprotection. Am J Obstet Gynecol 204: 202.e1-4.

20. Mittendorf R, Covert R, Bowman J, et al. (1997) Is tocolytic magnesium sulfate associated with increased total pediatric mortality. Lancet 350: 1517-8.    

21. Crowther CA, Hiller JE, Doyle LW, Haslam RR. (2003) Effect of magnesium sulfate given for neuroprotection before preterm birth: a randomized controlled trial. JAMA 290: 2669-76.    

22. Farkouh LJ,Thorp JA, Jones PG, Clark RH, Knox GE. (2001) Antenatal magnesium exposure and neonatal demise. Am J Obstet Gynecol 185: 869-72.    

23. Mittendorf R, Dambrosia J, Pryde PG, et al. (2002) Associationbetween the use of antenatal magnesium sulfate in preterm labor and adverse health outcomes in infants. Am J Obstet Gynecol 186: 1111-8.    

24. Elliott JP, Morrison JC. The Evidence Regarding Maintenance Tocolysis. Obstetrics and Gynecology International Hindawi Publishing Corporation. Vol 2013, Article ID 708023, 11 pages. Available from: http://dx.doi.org/10.1155/2013/708023.

25. Yokoyama K, Takahashi N, Yada Y. (2010) Prolonged maternal magnesium administration and bone metabolism in neonates. Early Hum Dev 86: 187-91.    

26. Wedig KE, Kogan J, Schorry EK et al. (2006) Skeletal demineralization and fractures caused by fetal magnesium toxicity. J Perinatol 26: 371-4.    

27. Malaeb SN, Rassi A, Haddad MC. (2001) Bone mineralization in newborns whose mothers received magnesium sulfate for tocolysis of premature labor. Pediatr Radiol 34: 384-6.

28. Kaplan W, Haymond MW, Mckay S, Karaviti LP. (2006) Osteopenic effects of magnesium sulfate in multiple pregnancies. J Pediatric Endocrinology and Metabolism 19:1225-30.

29. Nassar AH, Sakhel K, Maarouf H et al. (2006) Adverse maternal and neonatal outcome of prolonged course of magnesium sulfate tocolysis. Acta Obstet Gynecol Scan 19: 1225-30.

30. Schanier RJ, Smith LG, Burns PA. (1997) Effects of long-term maternal intravenous magnesium sulfate therapy on neonatal calcium metabolism and bone mineral content. Gynecol Obstet Invest 43: 236-41.    

31. Doyle LE, Anderson PJ, Haslam R, et al. (2014) School-age outcomes of very preterm infants after antenatal treatment with magnesium sulfate vs. placebo. JAMA 312(11): 1105-13.

32. ACOG Practice Bulletin No. 33. (2002) Diagnosis and management of preeclampsia and eclampsia. American College of Obstetricians and Gynecologists. Obstet Gynecol 99: 159-67.

33. Keys S, Elliott JP. (1997) The therapeutic use of vaginal pessary as adjunctive treatment in patients with multiple gestations presenting with preterm labor and low fetal station. J Reprent Med 42: 751-5.

Copyright Info: © 2016, John P. Elliott, et al., licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution Licese (http://creativecommons.org/licenses/by/4.0)

Download full text in PDF

Export Citation

Article outline

Show full outline
Copyright © AIMS Press All Rights Reserved