Intrapartum magnesium for prevention of cerebral palsy: continuing controversy?

Abstract

The purpose of the present review is to review the literature regarding the use of antenatal magnesium sulfate (MgSO4) for fetal neuroprotection and prevention of cerebral palsy in women at risk of preterm delivery. Cerebral palsy is a nonprogressive disorder of movement and posture and a leading cause of childhood disability. Preterm birth is a major risk factor for the development of cerebral palsy; gestational age at delivery has an inverse relationship to the risk of cerebral palsy. Observational studies over the past 15 years have suggested a possible protective role for MgSO4. In some studies, children born preterm who were exposed prenatally to MgSO4 for obstetric indications such as seizure prophylaxis or tocolysis had decreased rates of cerebral palsy as compared with children born preterm to women who were not exposed to MgSO4. Randomized trials have been conducted to test the hypothesis that maternal MgSO4 exposure had neonatal neuroprotective effects. These studies included women thought to be at risk of preterm delivery within 24 h. The largest of these studies, published in 2008 by Dr Rouse et al., included more than 2000 women and found a decreased rate of moderate-to-severe cerebral palsy in surviving children born to women treated with MgSO4. MgSO4 treatment in women at high risk for preterm birth may reduce the risk of cerebral palsy in children who survive.