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Prenatal Intravenous Magnesium at 30-34 Weeks' Gestation and Neurodevelopmental Outcomes in Offspring: The MAGENTA
Caroline A Crowther1,2, Pat Ashwood2, Philippa F Middleton2,3
1Liggins Institute, University of Auckland, Auckland, New Zealand.
JAMA
|August 15, 2023
Summary
Administering magnesium sulfate to pregnant individuals between 30 and 34 weeks gestation did not reduce death or cerebral palsy in children by age 2. The study lacked power to detect small differences in outcomes.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Clinical Trials
Background:
- Intravenous magnesium sulfate (MgSO4) given before 30 weeks gestation reduces adverse outcomes in preterm infants.
- The efficacy of MgSO4 at later gestational ages (30-34 weeks) remains unclear.
Purpose of the Study:
- To determine if MgSO4 administered between 30 and 34 weeks gestation reduces death or cerebral palsy in children at 2 years corrected age.
- To assess secondary outcomes related to maternal and infant health.
Main Methods:
- A randomized clinical trial involving 1433 pregnant individuals at 30-34 weeks gestation across 24 hospitals.
- Participants received either intravenous MgSO4 (4g) or a placebo.
- Primary outcome: death or cerebral palsy at 2 years corrected age. 36 secondary outcomes were assessed.
Main Results:
- No significant difference in death or cerebral palsy at 2 years between MgSO4 and placebo groups (3.3% vs 2.7%).
- Magnesium group had reduced respiratory distress syndrome and chronic lung disease during hospitalization.
- Increased adverse events for mothers receiving MgSO4, including higher rates of major postpartum hemorrhage.
Conclusions:
- Administration of MgSO4 between 30 and 34 weeks gestation did not improve child survival free of cerebral palsy at 2 years.
- The study was underpowered to detect smaller between-group differences.
- While reducing some neonatal respiratory complications, MgSO4 use in this gestational window increased maternal adverse events.
