Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus

Abstract

Epidemiological and basic science evidence suggests that magnesium sulphate before birth may be neuroprotective for the fetus. To assess the effects of magnesium sulphate as a neuroprotective agent when given to women considered at risk of preterm birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2008). Randomised controlled trials of antenatal magnesium sulphate therapy in women threatening or likely to give birth at less than 37 weeks' gestational age. For one subgroup analysis, studies were broadly categorised by the primary intent of the study into "neuroprotective intent", or "other intent (maternal neuroprotective ‐ pre‐eclampsia)", or "other intent (tocolytic)". At least two authors assessed trial eligibility and quality, and extracted data. Five trials (6145 babies) were eligible for this review. Antenatal magnesium sulphate therapy given to women at risk of preterm birth substantially reduced the risk of cerebral palsy in their child (relative risk (RR) 0.68; 95% Confidence interval (CI) 0.54 to 0.87; five trials; 6145 infants). There was also a significant reduction in the rate of substantial gross motor dysfunction (RR 0.61; 95% CI 0.44 to 0.85; four trials; 5980 infants). No statistically significant effect of antenatal magnesium sulphate therapy was detected on paediatric mortality (RR 1.04; 95% CI 0.92 to 1.17; five trials; 6145 infants), or on other neurological impairments or disabilities in the first few years of life. Overall there were no significant effects of antenatal magnesium therapy on combined rates of mortality with cerebral palsy, although there were significant reductions for the neuroprotective groups RR 0.85; 95% CI 0.74 to 0.98; four trials; 4446 infants, but not for the other intent subgroups. There were higher rates of minor maternal side effects in the magnesium groups, but no significant effects on major maternal complications. The neuroprotective role for antenatal magnesium sulphate therapy given to women at risk of preterm birth for the preterm fetus is now established. The number of women needed to be treated to benefit one baby by avoiding cerebral palsy is 63 (95% confidence interval 43 to 155). Given the beneficial effects of magnesium sulphate on substantial gross motor function in early childhood, outcomes later in childhood should be evaluated to determine the presence or absence of later potentially important neurological effects, particularly on motor or cognitive function. Magnesium sulphate用於有早產風險之孕婦以對胎兒產生神經保護作用 流行病學和基礎科學證據認為，產前給予magnesium sulphate對於胎兒有神經保護作用。 評估將magnesium sulphate給予有早產風險之孕婦，對於胎兒的神經保護效果。 我們搜尋Cochrane Pregnancy和Childbirth Group's Trials Register (2008年8月31日)。 妊娠37週內有早產風險之婦女，產前使用magnesium sulphate治療之隨機對照試驗(Randomised controlled trials)。進行次組分析，將研究目的概分為「神經保護目的」或「其他目的(母親神經保護子癲前症)」或「其他目的(安胎)」。 至少有2位作者評估試驗適用性與品質和摘錄資料。 納入5篇試驗(6145名嬰兒)。產前使用magnesium sulphate治療有早產風險之婦女，相當程度地降低胎兒腦性麻痺的風險(RR為0.68; 95% CI為0.54 – 0.87 篇試驗；6145名嬰兒)。粗動作功能不佳(gross motor dysfunction)比率也顯著降低(RR為0.61; 95% CI為0.44 – 0.85 篇試驗；5980名嬰兒)。產前使用magnesium sulphate治療在小兒死亡率方面沒有統計上的顯著影響(RR為1.04; 95% CI為0.92 – 1.17; 5篇試驗; 6145名嬰兒)，出生後幾年內的其他神經缺損或失能也沒有顯著影響。整體而言，產前使用magnesium sulphate治療對於死亡率和腦性麻痺比率沒有顯著影響，僅有神經保護組有顯著降低(RR為0.85；95% CI為0.74 – 0.98；4篇試驗；4446名嬰兒)，其他目的之各組則無。magnesium sulphate組之輕微母親副作用比率較高，但是嚴重的母親併發症並不顯著。 早產風險之婦女產前使用magnesium sulphate治療，對於胎兒的神經保護角色現在已經確立。每治療63名婦女即可避免一名嬰兒發生腦性麻痺(95% CI為43 – 87)。因為magnesium sulphate對於幼童期的粗動作功能有改善，應評估之後孩童時期的結果以確認後來有無發生重要的神經影響，特別是動作或認知功能。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 有早產風險之婦女，產前使用magnesium sulphate治療，有助於保護胎兒的腦部和改善長期結果。早產嬰兒在出生後幾週的死亡風險高於足月嬰兒，存活者也經常有腦性麻痺(正常移動手腳的能力降低)、眼盲、失聰或生理失能等傷害，這會造成父母親極大的壓力。鎂是正常身體功能的一個重要元素。Magnesium sulphate可以幫助降低早產兒的腦部損傷，不過，母親可能會有潮紅、盜汗、噁心、嘔吐、頭痛和心悸等副作用。此次回顧檢視5篇試驗、6145名嬰兒，顯示magnesium sulphate治療可保護早產嬰兒免於腦性麻痺。 Sulfate de magnésium pour la neuroprotection du fœtus chez la femme présentant un risque d'accouchement prématuré Des preuves épidémiologiques et scientifiques de base suggèrent que l'administration de sulfate de magnésium avant la naissance peut jouer un rôle neuroprotecteur pour le fœtus. Évaler les effets du sulfate de magnésium en tant que neuroprotecteur chez les femmes considérées comme présentant un risque d'accouchement prématuré. Nous avons effectué des recherches dans le registre des essais cliniques du groupe Cochrane sur la grossesse et la naissance (31 août 2008). Essais contrôlés randomisés portant sur l'administration...