Abstract
BackgroundThere is conflicting evidence about the role of oral magnesium supplementation in the prevention of preterm birth and related adverse outcomes. The objective of this study was to compare magnesium citrate with placebo in the prevention of adverse perinatal and maternal outcomes among women at higher risk.MethodsThis multicenter, double-masked, placebo-controlled randomized superiority clinical trial compared oral magnesium citrate 300 mg to matched placebo, from 12 to 20 weeks’ gestation until delivery. This trial was completed in three centers in northeastern Brazil. Eligible women were those with a singleton pregnancy and ≥ 1 risk factor, such as prior preterm birth or preeclampsia, or current chronic hypertension or pre-pregnancy diabetes mellitus, age > 35 years or elevated body mass index. The primary perinatal composite outcome comprised preterm birth < 37 weeks’ gestation, stillbirth > 20 weeks, neonatal death or NICU admission < 28 days after birth, or small for gestational age birthweight < 3rd percentile. The co-primary maternal composite outcome comprised preeclampsia or eclampsia < 37 weeks, severe gestational hypertension < 37 weeks, placental abruption, or maternal stroke or death during pregnancy or ≤ 7 days after delivery.ResultsAnalyses comprised 407 women who received magnesium citrate and 422 who received placebo. The perinatal composite outcome occurred among 75 (18.4%) in the magnesium arm and 76 (18.0%) in the placebo group – an adjusted odds ratio (aOR) of 1.10 (95% CI 0.72–1.68). The maternal composite outcome occurred among 49 (12.0%) women in the magnesium arm and 41 women (9.7%) in the placebo group – an aOR of 1.29 (95% CI 0.83–2.00).ConclusionsOral magnesium citrate supplementation did not appear to reduce adverse perinatal or maternal outcomes in high-risk singleton pregnancies.Trial registrationClinicalTrials.gov NCT02032186, registered January 9, 2014.
Highlights
There is conflicting evidence about the role of oral magnesium supplementation in the prevention of preterm birth and related adverse outcomes
In 2016, a national study identified that the North and Northeast regions of Brazil had the highest rates of preterm birth, at 13.0 and 12.9%, respectively [14]
Factors associated with prematurity in Brazil are higher social vulnerability -low income, adolescent pregnancy and limited high school education – as well as inadequate prenatal care, a high rate of cesarean delivery and preeclampsia [15]
Summary
There is conflicting evidence about the role of oral magnesium supplementation in the prevention of preterm birth and related adverse outcomes. Prematurity is a leading cause of death in the neonatal period, and the second most common cause in children under age five years [1,2,3,4]. Brazil is among the top-10 countries with the highest number of premature births [1]. In 2016, a national study identified that the North and Northeast regions of Brazil had the highest rates of preterm birth, at 13.0 and 12.9%, respectively [14]. Factors associated with prematurity in Brazil are higher social vulnerability -low income, adolescent pregnancy and limited high school education – as well as inadequate prenatal care, a high rate of cesarean delivery and preeclampsia [15]
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