Neuroprotective effects of in utero exposure to magnesium sulfate
- Hyagriv N Simhan, MD, MS
Hyagriv N Simhan, MD, MS
- Professor & Chief, Division of Maternal-Fetal Medicine
- Executive Vice Chair, Obstetrical Services Department of Ob/Gyn/RS
- University of Pittsburgh School of Medicine
- Medical Director of Obstetrical Services
- Magee-Womens Hospital of UPMC
- Katherine P Himes, MD, MSCR
Katherine P Himes, MD, MSCR
- Assistant Professor of Obstetrics, Gynecology and Reproductive Sciences
- University of Pittsburgh School of Medicine
Cerebral palsy is the leading cause of neurologic impairment in young children, and prematurity and low birth weight are the most important risk factors for developing the disease. (See "Epidemiology, etiology, and prevention of cerebral palsy".)
In utero exposure to magnesium sulfate before early preterm birth appears to decrease the incidence and severity of cerebral palsy. The use of magnesium sulfate for neuroprotection will be reviewed here. Use of magnesium sulfate for tocolysis or for seizure prevention in women with preeclampsia/eclampsia is discussed separately. (See "Inhibition of acute preterm labor", section on 'Magnesium sulfate' and "Preeclampsia: Management and prognosis", section on 'Regimen'.)
The mechanism for the neuroprotective effects of magnesium sulfate in preterm infants is not well understood. The following mechanisms have been proposed [1,2]:
●Stabilization of cerebral circulation by stabilizing blood pressure and normalizing cerebral blood flow
●Prevention of excitatory injury by stabilization of neuronal membranes and blockade of excitatory neurotransmitters, such as glutamateTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- 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.
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- EVIDENCE OF EFFICACY FROM RANDOMIZED TRIALS AND META-ANALYSES
- Death and/or cerebral palsy
- Other short-term outcomes
- Outcomes at school-age
- CLINICAL APPROACH
- Candidates for treatment
- - Contraindications
- Gestational age
- - Lower limit
- - Upper limit
- Side effects
- Choice of tocolytic for women in preterm labor
- GUIDELINES FROM SELECTED ORGANIZATIONS
- SUMMARY AND RECOMMENDATIONS