Women at risk of preterm birth should be given magnesium sulphate to reduce the risk of cerebral palsy in their children says a new Scientific Advisory Committee paper published today by the Royal College of Obstetricians and Gynaecologists (RCOG).
The prevalence of preterm birth is increasing and despite the survival rate of preterm babies improving, the incidence of cerebral palsy (CP) is also increasing.
The incidence of CP decreases significantly with increasing gestational age: 14.6% at 22 to 27 weeks of gestation, 6.2% at 28 to 31 weeks, 0.7% at 32 to 36 weeks, and 0.1% in term infants.
In the late 1990s studies of infants born to mothers given magnesium sulphate found a reduction in rates of CP. Following on from that, five randomised controlled trials (RCTs), three subsequent meta analyses and a Cochrane review were undertaken.
The Cochrane review of trials concluded that antenatal magnesium sulphate therapy given to women at risk of preterm birth substantially reduced the risk of CP in their children.
On the basis of these studies, the University of Adelaide issued a clinical practice guideline on the use of antenatal magnesium sulphate prior to preterm birth for the neuroprotection of the baby in March 2010. The authors concluded that in women at risk of early preterm imminent birth, magnesium sulphate should be used for neuroprotection of the fetus, infant and child.
The clinical practice guidelines also state that magnesium sulphate should be considered in women at less than 30 weeks of gestation as it is more effective at earlier stages.
In addition, it is not associated with adverse long term fetal or maternal outcomes. Women should be advised of an increase in minor side effects associated with the medication such as facial flushing, sweating and nausea.
The Scientific Advisory Committee paper concludes that this evidence is not new, however, it has not lead to a wide-spread change in clinical practice in the UK. Magnesium sulphate is an important component of a care package to improve neonatal outcome following pre-term birth and the
Australian guidelines provide a well-reasoned, practical guide on which to base local clinical guidelines.
Dr Anna Kenyon, UCL Institute for Women’s Health and co-author of the paper said:
“Obstetricians are already familiar with giving a similar magnesium sulphate regime to women at risk of pre-eclampsia and know that major maternal side-effects are uncommon.
“Magnesium sulphate can help reduce the risk of cerebral palsy, a disabling condition and should therefore be more widely used.”
Professor Donald Peebles, UCL Institute for Women’s Health co-author of the paper added:
“The Australian guidelines provide excellent advice for clinicians and I hope this new Scientific Advisory Committee paper raises the awareness of using magnesium sulphate to reduce the rates of cerebral palsy.
“Magnesium sulphate should be considered in women at less than 30 weeks gestation as the benefits are largest at earlier stages and it is not associated with adverse long term side effects.”
To read the full guideline please click here.
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