Association between Cerebral Palsy or Death and Umbilical Cord Blood Magnesium Concentration

Abstract

Objective This study aims to evaluate whether magnesium sulfate (MgSO₄) infusion at the time of delivery or magnesium cord blood concentration is associated with cerebral palsy (CP) or death diagnosed by the age of 2 years.

Methods Secondary analysis of data from a randomized trial of MgSO₄ versus placebo for prevention of CP or death among offspring of women with anticipated preterm delivery. This study cohort included singleton, nonanomalous fetuses, whose mothers received MgSO₄ as neuroprophylaxis. The primary outcomes were CP or death diagnosed by the age of 2 years.

Results A total of 936 neonates (93 with CP or death, 843 controls) were included in the analysis. Infants in the group with CP or death had MgSO₄ infusing at delivery at a similar frequency to that of controls (49 [52.7%] vs. 463 [54.9%], p = 0.68). Mean concentrations of cord blood magnesium, available for 596 neonates, also were not different between the two groups (2.7 ± 0.9 vs. 2.6 ± 0.9 mEq/L, p = 0.66, respectively). Multivariable analyses did not alter these findings.

Conclusion Among the offspring of women exposed to MgSO₄, in utero, neither MgSO₄ infusion at the time of delivery nor magnesium cord blood concentration is associated with CP or death.

Keywords

cerebral palsy - cord blood - magnesium sulfate - preterm delivery

Note

Poster presented at: 35th annual meeting of the Society for Maternal-Fetal Medicine; Feb 2–7, 2015; San Diego, CA.

• References

• 1 Doyle LW, Crowther CA, Middleton P, Marret S, Rouse D. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev 2009; 1 (1) CD004661
• 2 Crowther CA, Hiller JE, Doyle LW, Haslam RR ; Australasian Collaborative Trial of Magnesium Sulphate (ACTOMg SO4) Collaborative Group. Effect of magnesium sulfate given for neuroprotection before preterm birth: a randomized controlled trial. JAMA 2003; 290 (20) 2669-2676
• 3 Marret S, Marpeau L, Zupan-Simunek V , et al; PREMAG trial group. Magnesium sulphate given before very-preterm birth to protect infant brain: the randomised controlled PREMAG trial. BJOG 2007; 114 (3) 310-318
• 4 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 (9) 895-905
• 5 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 (3) 669-671
• 6 Hirtz DG, Nelson K. Magnesium sulfate and cerebral palsy in premature infants. Curr Opin Pediatr 1998; 10 (2) 131-137
• 7 McPherson JA, Rouse DJ, Grobman WA, Palatnik A, Stamilio DM. Association of duration of neuroprotective magnesium sulfate infusion with neonatal and maternal outcomes. Obstet Gynecol 2014; 124 (4) 749-755
• 8 Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39 (4) 214-223
• 9 Hallak M, Cotton DB. Transfer of maternally administered magnesium sulfate into the fetal compartment of the rat: assessment of amniotic fluid, blood, and brain concentrations. Am J Obstet Gynecol 1993; 169 (2 Pt 1) 427-431
• 10 McDonald JW, Silverstein FS, Johnston MV. Magnesium reduces N-methyl-D-aspartate (NMDA)-mediated brain injury in perinatal rats. Neurosci Lett 1990; 109 (1-2) 234-238
• 11 Marret S, Doyle LW, Crowther CA, Middleton P. Antenatal magnesium sulphate neuroprotection in the preterm infant. Semin Fetal Neonatal Med 2007; 12 (4) 311-317
• 12 Burd I, Breen K, Friedman A, Chai J, Elovitz MA. Magnesium sulfate reduces inflammation-associated brain injury in fetal mice. Am J Obstet Gynecol 2010; 202 (3) 292.e1-292.e9