Am J Perinatol 2012; 29(10): 795-800
DOI: 10.1055/s-0032-1316440
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neonatal Effects of Magnesium Sulfate Given to the Mother

Mina Abbassi-Ghanavati
1   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
James M. Alexander
1   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Donald D. McIntire
1   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Rashmin C. Savani
2   Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
,
Kenneth J. Leveno
1   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
› Author Affiliations
Further Information

Publication History

01 December 2011

13 March 2012

Publication Date:
06 July 2012 (online)

Abstract

Objective Magnesium historically has been used for treatment and/or prevention of eclampsia or preterm labor. More recently, antepartum magnesium sulfate has been suggested for prevention of cerebral palsy in preterm infants. Although adverse effects and toxicity of magnesium in pregnant women are well known, the fetal-neonatal effects of magnesium are less clear. The objective of this study was to evaluate the effects of magnesium on the newborn infant.

Study Design This is a retrospective cohort analysis of women who received antepartum magnesium sulfate for prevention or treatment of eclampsia. Magnesium sulfate was given intravenously beginning with a 6-g dose, followed by 2- to 3-g/h infusion. Newborn hypotonia was diagnosed if an infant exhibited less than normal tone/activity upon admission to the nursery.

Results Between January 2000 and February 2009, a total of 6654 women with preeclampsia were treated with intravenous magnesium sulfate as described; 88 (6%) of the infants were diagnosed with hypotonia. Lower 1-minute and 5-minute Apgar scores, intubation in the delivery room, admission to special care nursery, and hypotonia were all significantly increased as maternal serum magnesium concentrations increased before birth.

Conclusion Several neonatal complications are significantly related to increasing concentrations of magnesium in the maternal circulation.

 
  • References

  • 1 Belfort MA, Anthony J, Saade GR, Allen Jr JC ; Nimodipine Study Group. A comparison of magnesium sulfate and nimodipine for the prevention of eclampsia. N Engl J Med 2003; 348: 304-311
  • 2 Grimes DA, Nanda K. Magnesium sulfate tocolysis: time to quit. Obstet Gynecol 2006; 108: 986-989
  • 3 Rouse DJ, Hirtz DG, Thom E , et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008; 359: 895-905
  • 4 American College of Obstetricians and Gynecologists Committee on Obstetric Practice; Society for Maternal-Fetal Medicine. Committee Opinion No. 455: Magnesium sulfate before anticipated preterm birth for neuroprotection. Obstet Gynecol 2010; 115: 669-671
  • 5 Pearson HA, Wray D. Non-competitive antagonism of calcium by magnesium ions at the K(+)-depolarised mouse neuromuscular junction. Eur J Pharmacol 1993; 236: 323-326
  • 6 Lipsitz PJ, English IC. Hypermagnesemia in the newborn infant. Pediatrics 1967; 40: 856-862
  • 7 Rasch DK, Huber PA, Richardson CJ, L'Hommedieu CS, Nelson TE, Reddi R. Neurobehavioral effects of neonatal hypermagnesemia. J Pediatr 1982; 100: 272-276
  • 8 Green KW, Key TC, Coen R, Resnik R. The effects of maternally administered magnesium sulfate on the neonate. Am J Obstet Gynecol 1983; 146: 29-33
  • 9 Riaz M, Porat R, Brodsky NL, Hurt H. The effects of maternal magnesium sulfate treatment on newborns: a prospective controlled study. J Perinatol 1998; 18 (6 Pt 1) 449-454
  • 10 National High Blood Pressure Education Program Working Group. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000; 183: S1-S22
  • 11 ACOG Committee on Practice Bulletins—Obstetrics. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstet Gynecol 2002; 99: 159-167
  • 12 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92: 529-534
  • 13 Lipsitz PJ. The clinical and biochemical effects of excess magnesium in the newborn. Pediatrics 1971; 47: 501-509
  • 14 Stone SR, Pritchard JA. Effect of maternally administered magnesium sulfate on the neonate. Obstet Gynecol 1970; 35: 574-577
  • 15 Donovan EF, Tsang RC, Steichen JJ, Strub RJ, Chen IW, Chen M. Neonatal hypermagnesemia: effect on parathyroid hormone and calcium homeostasis. J Pediatr 1980; 96: 305-310
  • 16 Chesley LC. Hypertensive Disorders in Pregnancy. New York: Appleton-Century-Crofts; 1978
  • 17 Kohn LT, Corrigan JM, Donaldson MS , eds. To Err Is Human: Building a Safer Health System. Washington, DC: Institute of Medicine and the National Academy Press; 1999
  • 18 The Institution for Safe Medication Practices List of High Alert Medication. http://www.ismp.org/Tools/highalertmedications.pdf . Accessed June 5, 2012
  • 19 Simpson KR, Knox GE. Obstetrical accidents involving intravenous magnesium sulfate: recommendations to promote patient safety. MCN Am J Matern Child Nurs 2004; 29: 161-169 ; quiz 170–171