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Magnesium sulfate use for fetal neuroprotection

Brookfield, Kathleen F.; Vinson, Abigail

Current Opinion in Obstetrics and Gynecology: April 2019 - Volume 31 - Issue 2 - p 110–115
doi: 10.1097/GCO.0000000000000529
MATERNAL FETAL MEDICINE: Edited by Deirdre Lyell, Mark Boddy, and Martha Rode

Purpose of review The aim of this review is to describe the proposed mechanisms of action of magnesium sulfate for fetal neuroprotection, different dosing regimens of the drug that have shown benefit, and to review recent pharmacokinetic studies of the drug to better inform clinicians regarding expected benefits and remaining research questions.

Recent findings Retrospective secondary analysis of the beneficial effects of antenatal magnesium sulfate trial database and prospective pharmacokinetic/pharmacodynamic modeling indicate magnesium sulfate administration for duration longer than 18 h, given within 12 h of delivery, and maintaining a maternal serum level of 4.1 mg/dl may maximize the neuroprotective benefits of the drug.

Summary Magnesium sulfate in some dosage given before very preterm pregnancy delivery is beneficial for fetal neuroprotection. The exact dose, duration, and timing of administration to maximize this benefit may be more precisely studied using pharmacokinetic/pharmacodynamic modeling techniques before conducting larger randomized trials.

Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA

Correspondence to Kathleen F. Brookfield, MD, PhD, MPH, Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. Tel: +1 505 346 1191; e-mail:

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