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| |  SMFM: Magnesium Sulfate Does Not Alter Progression of Mild to Severe Pre-eclampsia By Cameron Johnston Special to DG News NEW ORLEANS, LA -- January 22, 2002 -- Magnesium sulfate does not slow the progression of mild pre-eclampsia to the more severe form of the disease. Magnesium sulfate by intraveous (IV) injection is the treatment of choice for pre-eclampsia. To date, only one randomised clinical study has evaluated the efficacy of magnesium sulfate in this disease. Jeffrey Livingston, MD, of the department of obstetrics and gynecology at the University of Tennessee Health Sciences Center, in Memphis, Tennessee,and colleagues conducted a study to determine whether magnesium sulfate can prevent progression of pre-eclampsia. He presented the study results in an oral presentation on January 18th at the 22nd annual meeting of the Society for Maternal-Fetal Medicine (SMFM), in New Orleans, Louisiana, United States. Magnesium sulfate is not a benign drug, and its use has been associated with significant adverse drug reactions, including maternal overdose, administration errors, blood loss, and infectious morbidities, Dr. Livingston said. This double-blind study involved 222 women, from a single institution, who were diagnosed with mild pre-eclampsia according to the American College of Obstetricians and Gynecologists (ACOG). The women had a systolic blood pressure higher than 140 mm Hg and a diastolic blood pressure higher than 90 mm Hg, measured on at least two occasions, six hours apart. All patients were enrolled at delivery admission. Patients who had end organ involvement or severe eclampsia, as defined by a blood pressure higher than 160/110 mm Hg, were excluded from the study. Patients were treated with magnesium sulfate 6 g bolus over 15 minutes followed by maintenance dosing of 2 g/hr during labour and/or for 12 hours post-partum. One-hundred-and-nine patients received IV magnesium sulfate treatment and 113 received an IV placebo. The mean age of the subjects was 21 years, none were obese, and mean gestational age was 38.5 weeks.There were no differences in parity between the groups. Approximately 80 percent of women in each group were African American. Results show that magnesium sulfate did not prevent progression to the severe form of pre-eclampsia, with 12.8 percent of women who received magnesium sulfate progressing to severe pre-eclampsia compared to 16.8 percent of those who received placebo (p=0.41). Other patient characteristics were similar between the two groups. Magnesium sulfate did not affect mean arterial blood pressure. Women in the magnesium group had a mean arterial blood pressure of 120 mm Hg compared to 122 mm Hg in the placebo group. There were no differences in the rate of birth by caesarean delivery (30 percent for the magnesium group vs. 27 percent for the placebo group, p=0.61), amount of blood loss (582 ml in the magnesium group vs. 546 ml in the placebo group, p=0.49), incidence of infectious morbidity (2.5 percent in both groups), and incidence of post-partum endometritis (3.9 percent in the magnesium group vs. 4.5 percent in the placebo group). Also, there were no meaningful differences in one-minute or five-minute Apgar scores for newborns between the groups. On the basis of these results, the researchers concluded that magnesium sulfate does not alter the progression to severe pre-eclampsia. In addition, they found that mild eclamptic seizures are rare in women with mild pre-eclampsia who are under close observation. Magnesium sulfate therapy has few adverse effects in women with mild pre-eclampsia, Dr. Livingston noted. The beneficial effects of magnesium sulfate in these women reported previously are unfounded and caution should be exercised when using it, if it is used at all, he said. Magnesium therapy should be tailored to the individual patient, Dr. Livingston said, and in cases where it is used, it should be withdrawn once the patient’s blood pressure has returned to mild eclampsia levels. "This is another call for large randomised multi-centre trials," Dr. Livingston concluded. "Eighty percent of women with pre-eclampsia have mild disease and they are being treated with magnesium sulfate when there are no randomly controlled trials to support this."
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