Magnesium Sulfate-Mediated Inflammatory Modulation in High-Risk Pregnancies: Dynamic Shifts in CBC-Derived Markers...

To evaluate the effect of magnesium sulfate (MgSO₄) therapy on dynamic changes in maternal inflammation-based hematologic indices and their predictive value for neonatal outcomes in high-risk pregnancies.

We conducted a retrospective cohort study involving 236 singleton pregnancies treated with MgSO₄ for either fetal neuroprotection or seizure prophylaxis. Pre- and 24-h post-treatment complete blood count (CBC)-derived inflammatory markers (including neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], systemic inflammation response index [SIRI], and mean platelet volume [MPV]) were compared. Percentage change (Δ) values were calculated. Associations between these Δ-values and adverse perinatal outcomes were analyzed using correlation tests and ROC curves.

Following MgSO₄ administration, significant alterations were observed in maternal inflammatory markers: NLR (+12.2%), WBC (+11.7%), SIRI (+25.6%) increased, whereas PLR (-9.7%), LMR (-6.1%), and platelet count (-9.6%) decreased (all p < 0.05). ΔNLR, ΔMPV, and ΔWBC correlated negatively with gestational age and birth weight, and positively with NICU admission. ROC analysis identified ΔNLR ≥ -15.132 as a predictor of NICU admission (AUC = 0.609, p = 0.016).

Magnesium sulfate induces measurable changes in maternal inflammatory profiles. These dynamic hematologic shifts-especially in NLR and MPV-may carry limited predictive value for adverse neonatal outcomes. Monitoring ∆-inflammatory indices could support exploratory efforts in risk stratification, but further validation is required before clinical application.