Magnesium sulfate for neuroprotection before preterm birth: Uptake and adherence in clinical practice after National...

Magnesium sulfate (MgSO₄) administered before very preterm birth reduces the risk of cerebral palsy in surviving infants and is recommended in international guidelines. In April 2020, a national guideline for MgSO₄ for fetal neuroprotection was introduced in Denmark. We evaluated clinical uptake and adherence following guideline implementation.

This retrospective medical chart review study included women who delivered at gestational age 24 + 0 to 31 + 6 weeks of gestation at nine different Danish hospitals between April 2020 and December 2023. These departments handled around 50% of all deliveries in Denmark in this period. Data were obtained from electronic medical records. The primary outcome was administration of MgSO₄ for fetal neuroprotection among eligible women. Secondary outcomes included temporal trends in uptake, differences by gestational age and hospital size, and documented reasons for non-administration. Descriptive statistics were used to summarize uptake rates and patient characteristics, and comparisons were performed using appropriate statistical tests.

A total of 583 eligible women were included. Overall, 481 women (83%) received MgSO₄ for fetal neuroprotection; of these, 340 women (71%) received MgSO₄ within 24 h of birth. Uptake was highest among women delivering before 28 weeks of gestation, where MgSO₄ was administered in nearly all eligible cases. Among women delivering between 28 + 0 and 31 + 6 weeks, approximately one in five did not receive treatment. Uptake did not increase over the study period, suggesting early adoption followed by stable implementation. Large-volume hospitals demonstrated higher treatment rates compared with smaller hospitals. The most frequent reasons for non-administration were lack of guideline awareness/oversight at later gestational ages and rapid delivery or maternal/fetal instability at earlier gestations.

Following the implementation of the national guideline, uptake of MgSO₄ for fetal neuroprotection in Denmark was high but incomplete. Persistent gaps in treatment, particularly among women delivering after 28 weeks of gestation, indicate a need for targeted implementation strategies to improve adherence and ensure equitable neuroprotective care.