1 g/h magnesium sulfate maintenance for eclampsia prevention is enough

Area of Science:

• Obstetrics and Gynecology
• Pharmacology
• Evidence-Based Medicine

Background:

• Eclampsia is a severe complication of preeclampsia, posing significant risks to maternal and fetal health.
• Magnesium sulfate is a key treatment for preventing eclampsia in pregnant individuals.
• Optimal dosing regimens for magnesium sulfate maintenance therapy require further clarification.

Purpose of the Study:

• To systematically review randomized controlled trials (RCTs) comparing magnesium sulfate versus placebo for eclampsia prevention.
• To compare the efficacy and safety of 2 g/h versus 1 g/h magnesium sulfate maintenance regimens in preventing eclampsia.

Main Methods:

• Two systematic reviews of RCTs were conducted, searching multiple databases (Medline, Cochrane Library, EMBASE, PubMed Central, Scopus, ClinicalTrials.gov) up to February 2025.
• Included studies compared magnesium sulfate vs. placebo/no treatment and 2 g/h vs. 1 g/h maintenance doses.
• Meta-analyses were performed to calculate odds ratios (OR) and confidence intervals (CI) for eclampsia incidence and maternal side effects.

Main Results:

• In comparisons of magnesium sulfate vs. placebo, eclampsia incidence was 0.57% with a 2 g/h regimen and 0.76% with a 1 g/h regimen (OR 1.33).
• Maternal side effects were significantly higher with the 2 g/h regimen (67%) compared to the 1 g/h regimen (22%) (OR 7.05).
• In comparisons of 2 g/h vs. 1 g/h maintenance regimens, no eclampsia cases were reported, but side effects were higher with the 2 g/h dose (71% vs. 42%, OR 1.69).

Conclusions:

• A 1 g/h magnesium sulfate maintenance regimen appears to be as effective as a 2 g/h regimen in preventing eclampsia.
• The 1 g/h regimen is associated with a significantly lower incidence of maternal side effects.
• The findings support the use of a 1 g/h magnesium sulfate maintenance regimen for eclampsia prevention due to its comparable efficacy and improved safety profile.