Effect of Cord Blood Magnesium Level at Birth on Non-neurologic Neonatal Outcomes

Abstract

Objective We examined the effects of magnesium sulfate on non-neurologic neonatal outcomes with respect to cord blood magnesium level.

Study Design We conducted a secondary analysis of the Maternal-Fetal Medicine Units Beneficial Effects of Antenatal Magnesium (MFMU BEAM) trial comparing the upper and lower quintiles of cord blood magnesium level. Outcomes included cerebral palsy (CP), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), and assessments of mental and motor disability. Logistic regression was used to estimate adjusted odds ratios (aORs) of each outcome, controlling for gestational age (GA), birth weight, and treatment group (TG).

Results A total of 1,254 women of the 2,444 included in the BEAM trial had cord blood magnesium levels recorded. GA and birth weight were lower and TG was more common in the upper quintile cohort (p < 0.001). Neonates in the upper quintile were more likely to have severe NEC (OR, 2.41, 95% confidence interval [CI]: 1.11–5.24), ROP (OR, 1.65, 95% CI: 1.05–2.59), and BPD (OR, 1.70, 95% CI: 1.04–2.73). Adjustment for covariates demonstrated no difference in the NEC, ROP, and BPD rates, although there was a decrease in rates of mental disability index < 70 which was not seen in the unadjusted analysis (aOR, 0.49, 95% CI: 0.25–0.99).

Conclusion Higher cord blood magnesium levels do not appear to have adverse non-neurologic effects on the neonate and may demonstrate improvement in neurologic outcomes.

Keywords

magnesium sulfate - necrotizing enterocolitis - bronchopulmonary dysplasia - neuroprotection - pregnancy - preterm birth

Note

This article was presented as an oral abstract at the 37th Annual Pregnancy Meeting by the Society for Maternal-Fetal Medicine, Las Vegas, NV. January 28, 2017. The contents of this report represent the views of the authors and do not represent the views of the Eunice Kennedy Shriver National Institutes of Health.

• References

• 1 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 (09) 895-905
• 2 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; (01) CD004661
• 3 Costantine MM, Weiner SJ. ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Effects of antenatal exposure to magnesium sulfate on neuroprotection and mortality in preterm infants: a meta-analysis. Obstet Gynecol 2009; 114 (2 Pt 1): 354-364
• 4 Palatnik A, Rouse DJ, Stamilio DM, McPherson JA, Grobman WA. Association between cerebral palsy or death and umbilical cord blood magnesium concentration. Am J Perinatol 2015; 32 (13) 1263-1267
• 5 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 (04) 749-755
• 6 Lamhot VB, Khatib N, Ginsberg Y. , et al. Magnesium sulfate prevents maternal inflammation-induced impairment of learning ability and memory in rat offspring. Am J Obstet Gynecol 2015; 213 (06) 851.e1-851.e8
• 7 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 (03) 292.e1-292.e9
• 8 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
• 9 Rattray BN, Kraus DM, Drinker LR, Goldberg RN, Tanaka DT, Cotten CM. Antenatal magnesium sulfate and spontaneous intestinal perforation in infants less than 25 weeks gestation. J Perinatol 2014; 34 (11) 819-822
• 10 Kamyar M, Clark EA, Yoder BA, Varner MW, Manuck TA. Antenatal magnesium sulfate, necrotizing enterocolitis, and death among neonates < 28 weeks gestation. AJP Rep 2016; 6 (01) e148-e154
• 11 Doyle LW, Anderson PJ, Haslam R, Lee KJ, Crowther C. ; Australasian Collaborative Trial of Magnesium Sulphate (ACTOMgSO4) Study Group. School-age outcomes of very preterm infants after antenatal treatment with magnesium sulfate vs placebo. JAMA 2014; 312 (11) 1105-1113
• 12 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. ; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147 (08) 573-577
• 13 Rigo J, Pieltain C, Christmann V. , et al. Serum magnesium levels in preterm infants are higher than adult levels: a systematic literature review and meta-analysis. Nutrients 2017; 9 (10) E1125
• 14 Johnson LH, Mapp DC, Rouse DJ. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Association of cord blood magnesium concentration and neonatal resuscitation. J Pediatr 2012; 160 (04) 573-577
• 15 Turitz AL, Too GT, Gyamfi-Bannerman C. Proximity of magnesium exposure to delivery and neonatal outcomes. Am J Obstet Gynecol 2016; 215 (04) 508.e1-508.e6