Term Neonatal Outcomes after Maternal Magnesium Sulfate Treatment for Seizure Prophylaxis

Rebecca Chornock; Elissa Trieu; Tetsuya Kawakita; Brynley Dean; Rachael Overcash

doi:10.1055/a-2011-8369

American Journal of Perinatology, Table of Contents

Am J Perinatol 2023; 40(09): 923-928
DOI: 10.1055/a-2011-8369

SMFM Fellowship Series Article

Term Neonatal Outcomes after Maternal Magnesium Sulfate Treatment for Seizure Prophylaxis

Authors

Rebecca Chornock

¹Division of Maternal-Fetal Medicine, Department of Women's and Infant's Services, MedStar Washington Hospital Center, Washington, District of Columbia
Elissa Trieu

¹Division of Maternal-Fetal Medicine, Department of Women's and Infant's Services, MedStar Washington Hospital Center, Washington, District of Columbia
Tetsuya Kawakita

²Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
Brynley Dean

³Georgetown University School of Medicine, Washington, District of Columbia
Rachael Overcash

¹Division of Maternal-Fetal Medicine, Department of Women's and Infant's Services, MedStar Washington Hospital Center, Washington, District of Columbia

Abstract

Objective This study aimed to evaluate term neonatal outcomes after maternal magnesium sulfate (MgSO₄) treatment for seizure prophylaxis.

Study Design This was a single-site retrospective cohort study of all women with term singleton gestation requiring MgSO₄ treatment for seizure prophylaxis and their respective neonatal outcomes from January 2013 through December 2020. Our primary outcome was neonatal intensive care unit (NICU) admission. We compared outcomes between women treated with MgSO₄ for 24 hours or more and women treated with MgSO₄ for less than 24 hours prior to delivery. Multivariable logistic regression was performed to calculate adjusted odds ratio (aOR) and 95% confidence interval (95% CI), controlling for variables with a p < 0.05 based on bivariable analysis.

Results Of 834 women analyzed, 173 (20.7%) neonates were admitted to the NICU. Women treated with MgSO₄ for 24 hours or more compared with women treated with MgSO₄ for less than 24 hours were more likely to have neonates admitted to the NICU during their hospitalization (27.3 vs. 18.9%; p = 0.01), neonates requiring immediate NICU admission (24.6 vs. 18.3%; p < 0.01), and NICU admission for neonatal lethargy. After adjusting for covariates, only NICU admission due to neonatal lethargy remained statistically significant (aOR: 4.78 [95% CI: 1.50–15.21]).

Conclusion Prolonged MgSO₄ treatment for 24 hours or more was associated with increased odds of term NICU admission due to neonatal lethargy.

Key Points

NICU admission rose with longer magnesium treatment.
Nulliparous patients had more magnesium sulfate exposure.
Obese patients had longer magnesium sulfate exposure.

Keywords

magnesium sulfate - term neonate - preeclampsia - NICU

Full Text

References

References
1 Altman D, Carroli G, Duley L. et al; Magpie Trial Collaboration Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet 2002; 359 (9321): 1877-1890
2 Sherwin CM, Balch A, Campbell SC. et al. Maternal magnesium sulphate exposure predicts neonatal magnesium blood concentrations. Basic Clin Pharmacol Toxicol 2014; 114 (04) 318-322
3 Abbassi-Ghanavati M, Alexander JM, McIntire DD, Savani RC, Leveno KJ. Neonatal effects of magnesium sulfate given to the mother. Am J Perinatol 2012; 29 (10) 795-799
4 Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on hypertension in pregnancy. Obstet Gynecol 2013; 122 (05) 1122-1131
5 Hallak M, Berry SM, Madincea F, Romero R, Evans MI, Cotton DB. Fetal serum and amniotic fluid magnesium concentrations with maternal treatment. Obstet Gynecol 1993; 81 (02) 185-188
6 Gortzak-Uzan L, Mezad D, Smolin A, Friger M, Huleihel M, Hallak M. Increasing amniotic fluid magnesium concentrations with stable maternal serum levels: a prospective clinical trial. J Reprod Med 2005; 50 (11) 817-820
7 Girsen AI, Greenberg MB, El-Sayed YY, Lee H, Carvalho B, Lyell DJ. Magnesium sulfate exposure and neonatal intensive care unit admission at term. J Perinatol 2015; 35 (03) 181-185
8 Drassinower D, Friedman AM, Levin H, Običan SG, Gyamfi-Bannerman C. Does magnesium exposure affect neonatal resuscitation?. Am J Obstet Gynecol 2015; 213 (03) 424.e1-424.e5
9 Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol 2020; 135 (06) e237-e260
10 Tracy SK, Tracy MB, Sullivan E. Admission of term infants to neonatal intensive care: a population-based study. Birth 2007; 34 (04) 301-307
11 Yang X, Meng T. Admission of full-term infants to the neonatal intensive care unit: a 9.5-year review in a tertiary teaching hospital. J Matern Fetal Neonatal Med 2020; 33 (17) 3003-3009