1
|
Prasath A, Aronoff N, Chandrasekharan P, Diggikar S. Antenatal Magnesium Sulfate and adverse gastrointestinal outcomes in Preterm infants-a systematic review and meta-analysis. J Perinatol 2023; 43:1087-1100. [PMID: 37391507 DOI: 10.1038/s41372-023-01710-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/03/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION To evaluate the effect of antenatal magnesium sulfate (MgSO4) on mortality and morbidity outcomes related to the gastrointestinal system (GI) in preterm infants. METHODS Data sources: A systematic literature search was conducted in November 2022. PubMed, CINAHL Plus with Full Text (EBSCOhost), Embase (Elsevier), and CENTRAL (Ovid) were searched. There were 6695 references. After deduplication, 4332 remained. Ninety-nine full-text articles were assessed and forty four articles were included in the final analysis. STUDY ELIGIBILITY CRITERIA Randomized or quasi-randomized clinical trials and observational studies that evaluated at least one of the pre-specified outcomes were included. Preterm infants whose mothers were given antenatal MgSO4 were included and whose mothers did not receive antenatal MgSO4 were the comparators. The main outcomes and measures were: Necrotizing enterocolitis (NEC) (stage ≥ 2), surgical NEC, spontaneous intestinal perforation (SIP), feeding intolerance, time to reach full feeds, and GI-associated mortality. STUDY APPRAISAL AND SYNTHESIS METHODS A random-effects model meta-analysis was performed to yield pooled OR and its 95% CI for each outcome due to expected heterogeneity in the studies. The analysis for each predefined outcome was performed separately for adjusted and unadjusted comparisons. All included studies were assessed for methodological quality. The risk of bias was assessed using elements of the Cochrane Collaboration's tool 2.0 and the Newcastle-Ottawa Scale for randomized controlled trials (RCTs) and non-randomized studies (NRS), respectively. The study findings were reported as per PRISMA guidelines. RESULTS A total of thirty-eight NRS and six RCTs involving 51,466 preterm infants were included in the final analysis. There were no increased odds of stage ≥2 NEC, (NRS : n = 45,524, OR: 0.95; 95% CI: 0.84-1.08, I2- 5% & RCT's: n = 5205 OR: 1.00; 95% CI: 0.89-1.12, I2- 0%), SIP (n = 34,186, OR: 1.22, 95% CI: 0.94-1.58, I2-30%), feeding intolerance (n = 414, OR: 1.06, 95% CI: 0.64-1.76, I2-12%) in infants exposed to antenatal MgSO4. On the contrary, the incidence of surgical NEC was significantly lower in MgSO4 exposure infants (n = 29,506 OR:0.74; 95% CI: 0.62-0.90, ARR: 0.47%). Studies assessing the effect on GI-related mortality were limited to make any conceivable conclusion. The certainty of evidence (CoE) for all outcomes was adjudged as 'very low' as per GRADE. CONCLUSION Antenatal magnesium sulfate did not increase the incidence of gastrointestinal-related morbidities or mortality in preterm infants. With the current evidence concerns, regarding the adverse effects of MgSO4 administration leading to NEC/SIP or GI-related mortality in preterm infants should not be a hurdle in its routine use in antenatal mothers.
Collapse
Affiliation(s)
- Arun Prasath
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Nell Aronoff
- University Libraries, University at Buffalo, Buffalo, NY, USA
| | | | | |
Collapse
|
2
|
Verhaak A, Bakaysa S, Johnson A, Veronesi M, Williamson A, Grosberg B. Migraine treatment in pregnancy: A survey of comfort and treatment practices of women's healthcare providers. Headache 2023; 63:211-221. [PMID: 36695287 DOI: 10.1111/head.14436] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The objective of this study was to assess women's healthcare providers' treatment practices for pregnant women with migraine. BACKGROUND Migraine is associated with several maternal and fetal complications during pregnancy, including preeclampsia and preterm birth. Migraine treatment during pregnancy can present significant challenges due to lack of controlled clinical trials and risks associated with specific medications. METHODS Women's healthcare providers were queried regarding practice patterns and comfort with use of acute and preventive migraine treatments during pregnancy. The survey was distributed online. RESULTS The survey was completed by 92 women's healthcare providers (response rate 22.9% [92/402]), with most specializing in general obstetrics and gynecology (91% [83/92]). Approximately one-fourth (26% [24/92]) of respondents indicated they counseled women on migraine treatment in pregnancy as early as before pregnancy contemplation, while over one-third (35% [32/92]) counseled on migraine treatment once the patient became pregnant. The majority of respondents reported feeling somewhat or very comfortable with recommending (63% [58/92]) or continuing (64% [59/92]) acute treatments for pregnant patients with migraine, with highest comfort levels for acetaminophen (100% [92/92] for prescribing or continuing) and caffeine (94% [85/90] prescribing, 91% [82/90] continuing). Higher levels of discomfort were reported with triptans (88% [80/91] rarely or never prescribe during pregnancy). Survey respondents felt less comfortable with recommending preventive migraine treatments to pregnant patients (40% [37/92] somewhat or very comfortable), compared with a higher comfort level with continuing preventive medications (63% [58/92] somewhat or very comfortable). Highest comfort levels were reported with use of magnesium (69% [63/91] comfortable prescribing, 82% [75/92] comfortable continuing) and non-pharmacologic approaches (70% [62/89] comfortable prescribing, 84% [75/89] comfortable continuing). Nearly 40% (35/92) of respondents reported that they typically refer to neurologists or headache specialists for migraine treatment during pregnancy. CONCLUSION This survey of women's healthcare providers revealed varying levels of comfort regarding migraine management during pregnancy, and highlights the need for additional education regarding migraine treatment safety data during pregnancy.
Collapse
Affiliation(s)
- Allison Verhaak
- Hartford Healthcare Headache Center, Ayer Neuroscience Institute, West Hartford, Connecticut, USA.,Division of Health Psychology, The Institute of Living/Hartford Hospital, Hartford, Connecticut, USA.,Department of Neurology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Stephanie Bakaysa
- Department of Maternal Fetal Medicine, Hartford Healthcare, West Hartford, Connecticut, USA
| | - Amy Johnson
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Connecticut, USA.,Department of Obstetrics and Gynecology, Hartford HealthCare, West Hartford, Connecticut, USA
| | - Maria Veronesi
- Hartford Healthcare Headache Center, Ayer Neuroscience Institute, West Hartford, Connecticut, USA
| | - Anne Williamson
- Research Department, Hartford Hospital, Hartford, Connecticut, USA
| | - Brian Grosberg
- Hartford Healthcare Headache Center, Ayer Neuroscience Institute, West Hartford, Connecticut, USA.,Department of Neurology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| |
Collapse
|
3
|
Jiang H, Guo J, Li J, Li C, Du W, Canavese F, Baker C, Ying H, Hua J. Artificial Neural Network Modeling to Predict Neonatal Metabolic Bone Disease in the Prenatal and Postnatal Periods. JAMA Netw Open 2023; 6:e2251849. [PMID: 36689226 PMCID: PMC9871802 DOI: 10.1001/jamanetworkopen.2022.51849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/29/2022] [Indexed: 01/24/2023] Open
Abstract
Importance Early recognition of metabolic bone disease (MBD) in infants is necessary but difficult; an appropriate tool to screen infants at risk of developing MBD is needed. Objectives To develop a predictive model for neonates at risk for MBD in the prenatal and postnatal periods and detect the pivotal exposed factors in each period. Design, Setting, and Participants A diagnostic study was conducted from January 1, 2012, to December 31, 2021, in Shanghai, China. A total of 10 801 pregnant women (singleton pregnancy, followed up until 1 month after parturition) and their infants (n = 10 801) were included. An artificial neural network (ANN) framework was used to build 5 predictive models with different exposures from prenatal to postnatal periods. The receiver operating characteristic curve was used to evaluate the model performance. The importance of each feature was examined and ranked. Results Of the 10 801 Chinese women who participated in the study (mean [SD] age, 29.7 [3.9] years), 7104 (65.8%) were local residents, 1001 (9.3%) had uterine scarring, and 138 (1.3%) gave birth to an infant with MBD. Among the 5 ANN models, model 1 (significant prenatal and postnatal factors) showed the highest AUC of 0.981 (95% CI, 0.970-0.992), followed by model 5 (postnatal factors; AUC, 0.977; 95% CI, 0.966-0.988), model 4 (all prenatal factors; AUC, 0.850; 95% CI, 0.785-0.915), model 3 (gestational complications or comorbidities and medication use; AUC, 0.808; 95% CI, 0.726-0.891), and model 2 (maternal nutritional conditions; AUC, 0.647; 95% CI, 0.571-0.723). Birth weight, maternal age at pregnancy, and neonatal disorders (anemia, respiratory distress syndrome, and septicemia) were the most important model 1 characteristics for predicting infants at risk of MBD; among these characteristics, extremely low birth weight (importance, 50.5%) was the most powerful factor. The use of magnesium sulfate during pregnancy (model 4: importance, 21.2%) was the most significant predictor of MBD risk in the prenatal period. Conclusions and Relevance In this diagnostic study, ANN appeared to be a simple and efficient tool for identifying neonates at risk for MBD. Combining prenatal and postnatal factors or using postnatal exposures alone provided the most precise prediction. Extremely low birth weight was the most significant predictive factor, whereas magnesium sulfate use during pregnancy could be an important bellwether for MBD before delivery.
Collapse
Affiliation(s)
- Honglin Jiang
- Department of Mother and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Jialin Guo
- Department of Mother and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Li
- Department of Mother and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chunlin Li
- Department of Mother and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenchong Du
- Department of Psychology, Nottingham Trent University, Nottingham, United Kingdom
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Hospital and Faculty of Medicine, Lille, France
- Faculty of Medicine, Jeanne de Flandre Hospital, Rue Eugène Avinée, Lille, France
| | - Charlie Baker
- Department of Psychology, Nottingham Trent University, Nottingham, United Kingdom
| | - Hao Ying
- Department of Mother and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Hua
- Department of Mother and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
4
|
Jarman ML, Bennett MM, Louis JM, Clark RH, Tolia VN, Ahmad KA. Changing Tocolytic Exposures among Neonatal Intensive Care Unit Admitted Preterm Infants. Am J Perinatol 2022; 39:1745-1749. [PMID: 35045576 DOI: 10.1055/a-1745-3262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Since 2010, the American College of Obstetrics and Gynecology have released three committee opinions to recommend and reaffirm the utility of magnesium sulfate for neuroprotection and later for tocolysis to achieve antenatal steroid course completion in preterm labor. We sought to determine changes in antenatal magnesium sulfate exposure and other tocolytic agents for pregnancies resulting in neonatal intensive care unit (NICU)-admitted preterm infants. STUDY DESIGN Using the Pediatrix Clinical Data Warehouse, we evaluated all inborn infants delivered between 22 and 33 weeks' gestation and admitted to the intensive care units from 2009 to 2018. We classified patients based on antenatal exposure to tocolytic medications: calcium channel blockers (nifedipine and amlodipine), betamimetics (terbutaline, theophylline, and ritodrine), prostaglandin inhibitors (indomethacin), and magnesium sulfate. RESULTS A total of 229,781 patients met inclusion criteria. During the study period, magnesium sulfate exposure increased from 27.6 to 57.7% of births while betamimetic exposure decreased from 10.2 to 5.2%. Increasing magnesium sulfate exposure over time was seen at all gestational ages examined and magnesium exposure was most common between 23 and 31 weeks' gestation. By 2017 to 2018, 70.5% of 24 to 29 weeks' gestation NICU infants received exposure to at least one tocolytic agent while this remained at 53.7% of 32 to 33 weeks' NICU admitted infants. Antenatal steroid exposure increased from 74.8 to 87.4% during the study period. CONCLUSION For NICU-admitted preterm infants, prenatal exposure patterns to tocolytic agents has shifted since 2009 with prenatal magnesium sulfate exposure increasing significantly. Antenatal steroid exposure has risen concurrently. Exposure to tocolytic agents is the highest among preterm infants born between 24 and 29 weeks' gestation. KEY POINTS · Exposure to magnesium sulfate significantly increased from 2009 to 2018 for NICU admitted infants.. · Concurrently, the use of other tocolytics decreased significantly.. · The use of antenatal steroids has been rising over time..
Collapse
Affiliation(s)
- Meghan L Jarman
- Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Monica M Bennett
- Research Analytics and Development Cores, Baylor Scott and White Research Institute, Dallas, Texas
| | - Judette M Louis
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
| | - Reese H Clark
- MEDNAX Center for Research Education, Quality, and Safety, Sunrise, Florida
| | - Veeral N Tolia
- Department of Pediatrics, Baylor University Medical Center, Dallas, Texas.,Pediatrix Medical Group, Dallas, Texas
| | - Kaashif A Ahmad
- Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas.,MEDNAX Center for Research Education, Quality, and Safety, Sunrise, Florida.,Pediatrix Medical Group of San Antonio, San Antonio, Texas.,Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas.,Pediatrix and Obstetrix Specialists of Houston, Houston, Texas.,Department of Neonatology, The Woman's Hospital of Texas, Houston, Texas
| |
Collapse
|
5
|
Omori-Shimano S, Tominaga T, Ikeda K. Maternal magnesium sulfate administration increases early-onset hyperkalemia risk in premature infants: A propensity score-matched, case-control study. Pediatr Neonatol 2022; 64:119-125. [PMID: 36207264 DOI: 10.1016/j.pedneo.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/26/2022] [Accepted: 06/29/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Magnesium sulfate (MgSO4) is a common substance administered to pregnant women with preeclampsia or eclampsia to prevent and treat seizures or gestational hypertension. This study aimed to evaluate whether administering maternal magnesium sulfate increased the risk of early-onset hyperkalemia in preterm infants. METHODS This single-center, propensity score-matched, case-control study examined preterm infants born within 24-36 weeks of gestation using electronic medical records between January 2015 and June 2019, in the Saitama City Hospital, Japan. We categorized infants according to their maternal MgSO4 administration status. After adjusting for perinatal information and maternal treatment, we compared the incidence of the variables, including neonatal hyperkalemia, within 24 h after birth between the matched cohorts. All infants in Model 1 were analyzed separately, while in Model 2 infants with birth weight of less than 1000 g were excluded. RESULTS We enrolled 421 infants (maternal MgSO4 group, 124; control group, 297). Ninety-five infants in Model 1 and 86 in Model 2 were matched in each group using propensity scores, respectively. In the matched cohorts of both models, infants in the maternal MgSO4 group had a higher hyperkalemia incidence than did those in the control group (42.1% vs. 7.4% in Model 1, 44.2% vs. 5.8% in Model 2, respectively; p < 0.0001). However, there was no relationship between the duration of intrauterine exposure to MgSO4 and early-onset neonatal hyperkalemia incidence. CONCLUSION Our study demonstrated that maternal MgSO4 administration, even for a short period of time, may increase the risk of early-onset hyperkalemia in preterm infants. Accordingly, physicians should be cautious when administering serum potassium to infants born to mothers administered MgSO4, especially within 24 h after birth.
Collapse
Affiliation(s)
- Sayu Omori-Shimano
- Division of Neonatology, Departments of Pediatrics, Saitama City Hospital, Saitama, Japan
| | - Takahiro Tominaga
- Departments of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazushige Ikeda
- Division of Neonatology, Departments of Pediatrics, Saitama City Hospital, Saitama, Japan.
| |
Collapse
|
6
|
Inomata S, Yoshida T, Nagaoka M, Yasuda I, Aoki A, Tamura K, Kawasaki Y, Makimoto M, Matsumura K, Adachi Y. Effects of long‐term antenatal magnesium sulfate administration on the bone mineralization of preterm infants. J Obstet Gynaecol Res 2022; 48:3119-3127. [DOI: 10.1111/jog.15430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/11/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Satomi Inomata
- Division of Neonatology, Maternal and Perinatal Center Toyama University Hospital Toyama Japan
| | - Taketoshi Yoshida
- Division of Neonatology, Maternal and Perinatal Center Toyama University Hospital Toyama Japan
| | - Mitsuhide Nagaoka
- Division of Neonatology, Maternal and Perinatal Center Toyama University Hospital Toyama Japan
| | - Ippei Yasuda
- Department of Obstetrics and Gynecology University of Toyama Toyama Japan
| | - Aiko Aoki
- Department of Obstetrics and Gynecology University of Toyama Toyama Japan
| | - Kentaro Tamura
- Division of Neonatology, Maternal and Perinatal Center Toyama University Hospital Toyama Japan
| | - Yukako Kawasaki
- Division of Neonatology, Maternal and Perinatal Center Toyama University Hospital Toyama Japan
| | - Masami Makimoto
- Division of Neonatology, Maternal and Perinatal Center Toyama University Hospital Toyama Japan
| | - Kenta Matsumura
- Department of Public Health, Faculty of Medicine University of Toyama Toyama Japan
| | - Yuichi Adachi
- Department of Pediatrics, Faculty of Medicine University of Toyama Toyama Japan
| |
Collapse
|
7
|
Hira S, Ban R, Ogawa S, Sakai K, Takitani K, Ashida A. Antenatal mgnesium sulfate and ritodrine increased potassium levels in preterm infants: A cohort study. Pediatr Int 2022; 64:e15315. [PMID: 36331237 DOI: 10.1111/ped.15315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 07/08/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ritodrine and magnesium sulfate are administered to prevent preterm labor. Magnesium sulfate is also administered to prevent preeclampsia. These drugs have been reported to increase potassium levels in pregnant women and neonates. The aim of this study was to investigate the relationship between potassium levels in preterm infants and antenatal treatment. METHODS This prospective cohort study was conducted at Saiseikai Suita Hospital. Preterm infants born at <35 weeks' gestation between October 2012 and September 2014 were recruited and divided into four groups based on the antenatal treatment their mothers received. Serum and urine electrolyte levels at birth and serum potassium levels 1 day after birth were measured. RESULTS The mothers of 16 infants received no antenatal treatment (condition C); the mothers of 29 infants received antenatal ritodrine (R); the mothers of seven infants received magnesium sulfate (M); and the mothers of 15 infants received both magnesium sulfate and ritodrine (M + R). At birth, potassium levels were similar among the four groups. However, potassium levels a day after birth were significantly higher in the M + R group than in the other groups: median (min.-max.) mEq/L 4.8 (3.8-6.2), 4.8 (3.6-6.0), and 4.4 (3.8-5.9) vs. 5.8 (4.9-7.2), in the C, R, and M groups versus the M + R group, respectively (P < 0.01). Significantly more infants in the M + R group exhibited a fractional excretion of potassium of <10% compared with those in the other groups. CONCLUSION The increased potassium levels we observe in preterm infants of mothers who received antenatal magnesium sulfate and ritodrine administration on postnatal day 1 warrant monitoring by neonatologists.
Collapse
Affiliation(s)
- Seigo Hira
- Department of Pediatrics, Saiseikai Suita Hospital, Suita, Osaka, Japan
| | - Ryoichi Ban
- Department of Pediatrics, Saiseikai Suita Hospital, Suita, Osaka, Japan
| | - Satoru Ogawa
- Department of Pediatrics, Saiseikai Suita Hospital, Suita, Osaka, Japan
| | - Kyoko Sakai
- Department of Laboratory Medicine, Saiseikai Suita Hospital, Suita, Osaka, Japan
| | - Kimitaka Takitani
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Akira Ashida
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| |
Collapse
|
8
|
Tominaga T, Ikeda K, Awazu M. Transient hypercalcemia followed by hypocalcemia in a preterm infant after maternal magnesium sulfate therapy. Clin Pediatr Endocrinol 2022; 31:77-80. [PMID: 35431443 PMCID: PMC8981048 DOI: 10.1297/cpe.2021-0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/11/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Takahiro Tominaga
- Division of Neonatology, Departments of Pediatrics, Saitama City Hospital, Saitama, Japan
| | - Kazushige Ikeda
- Division of Neonatology, Departments of Pediatrics, Saitama City Hospital, Saitama, Japan
| | - Midori Awazu
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
9
|
Wen YH, Wang IT, Lin FJ, Hsu HY, Wu CH. Association between the prolonged use of magnesium sulfate for tocolysis and fracture risk among infants. Medicine (Baltimore) 2021; 100:e28310. [PMID: 34941123 PMCID: PMC8701460 DOI: 10.1097/md.0000000000028310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/23/2021] [Indexed: 01/05/2023] Open
Abstract
In 2013, the U.S. Food and Drug Administration issued a safety warning that cautioned against using magnesium sulfate (MgSO4) injections for more than 5 to 7 days to stop preterm delivery due to the bone problems subsequently observed in infants. However, the warning was mainly based on case reports, and further investigation is necessary to determine whether prolonged MgSO4 use increased infant fractures.To evaluate whether prolonged MgSO4 use for tocolysis increased the risk of subsequent fractures among infants.A retrospective population-based cohort study was conducted with a new-user study design using the National Health Insurance Database in Taiwan. We included pregnant women aged between 12 and 55 years old who delivered a live-born singleton. The enrollment period was from January 1, 2012 to December 31, 2014. The exposure group was defined as pregnant women who received MgSO4 injection for >5 days during pregnancy, while those not receiving any tocolytics were the reference group. The outcome was any bone fracture among the infants during the 2-year follow-up period. Propensity score matching and Cox proportional hazards regression models were used to estimate the hazard of fractures. We further studied the effect of MgSO4 treatment with varied dosages and durations of treatment in the sensitivity analyses.Among the 4092 pregnant women in the database, 693 (16.9%) of them were included in the exposure group. The hazard ratio of infant fractures among prolonged MgSO4 users was not significantly different from that of tocolytic nonusers in adjusted models (adjusted hazard ratio (aHR) = 1.48; 95% confidence interval (CI) = 0.59-3.71). A similar lack of significance was found in the sensitivity analyses (aHR = 1.45; 95% CI = 0.40-5.28 for larger treatment dosage; aHR = 2.52; 95% CI = 0.49-12.98 for longer treatment duration).Prolonged MgSO4 tocolysis use did not increase the risk of infant fractures. Our findings reconfirmed the safety of MgSO4 as a tocolytic treatment.
Collapse
Affiliation(s)
- Yung-Hsiang Wen
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - I-Te Wang
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsing-Yu Hsu
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Chung-Hsuen Wu
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
10
|
Magnesium sulfate pharmacokinetics after intramuscular dosing in women with preeclampsia. AJOG GLOBAL REPORTS 2021; 1:100018. [PMID: 36277458 PMCID: PMC9563381 DOI: 10.1016/j.xagr.2021.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/17/2021] [Accepted: 08/24/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Current intramuscular magnesium dosing regimens in low and middle-income countries are based on indirect absorption parameters to inform pharmacokinetic and pharmacodynamic response. OBJECTIVE To determine if therapeutic serum magnesium levels are obtained in women with severe preeclampsia receiving intramuscular administration of magnesium sulfate using the Pritchard regimen and to compare the key pharmacokinetic variables to those previously published. STUDY DESIGN Serum magnesium levels were obtained at multiple time points at baseline and after magnesium sulfate administration from women with severe preeclampsia receiving the standard Pritchard regimen for seizure prophylaxis at Bayero University, Kano, Nigeria. The pharmacokinetic profiles were constructed for the study cohort and the updated pharmacokinetic model was compared with the one that was previously published. RESULTS A total of 80 blood samples were collected from 20 women with severe preeclampsia (45 collected before childbirth and 35 collected after childbirth). After 11.5 hours of magnesium sulfate administration, 63% of women in the cohort had serum magnesium levels of ≥2.0 mmol/L. Data from women receiving the Pritchard regimen combined with data from women previously modeled after the receipt of intravenous magnesium sulfate were adequately described using a 2-compartment model with first-order absorption and linear elimination from the central compartment. All structural pharmacokinetic parameters including clearance, central volume of distribution, peripheral volume of distribution, and intercompartment clearance were adjusted for maternal weight, and the clearance was further adjusted for serum creatinine level and antepartum or postpartum status. The simulated pharmacokinetic profiles of the updated pharmacokinetic model and the previously published pharmacokinetic model are similar. In previously published pharmacokinetic modeling, absorption rate constant=0.32 and absolute bioavailability=0.86. In the updated pharmacokinetic model, absorption rate constant=0.45 and absolute bioavailability=0.91. CONCLUSION These data support the use of the Pritchard regimen as acceptable to achieve therapeutic serum magnesium levels and support the reported simulation of serum magnesium levels and eclampsia response associated with different intramuscular regimens.
Collapse
|
11
|
Alqahtani M, Barmherzig R, Lagman-Bartolome AM. Approach to Pediatric Intractable Migraine. Curr Neurol Neurosci Rep 2021; 21:38. [PMID: 34089140 DOI: 10.1007/s11910-021-01128-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Intractable migraine in children and adolescents is a significant cause of disability and decreased quality of life (QoL) in this population. Challenges include lack of unifying definition for intractable migraine, and limited data on best-practice management in this age group, with most current treatment pathways extrapolated from adult studies or expert consensus. RECENT FINDINGS A comprehensive approach in the evaluation and management of intractable migraine in this age group encompasses excluding secondary causes of headache; making an accurate diagnosis; identifying and appropriately managing modifiable risk factors; and initiating appropriate pharmacologic therapy to reduce disability, improve health-related quality of life, reduce risk of progression, and develop adaptive pain coping strategies. Several strategies for management of pediatric intractable migraine including use of acute medications, bridge therapy in outpatient setting, emerging therapies for preventive therapy, and a stepwise combination therapy for management of pediatric intractable migraine in emergency and inpatient setting are presented based on available clinical data, safety/tolerability, availability, cost-effectiveness, and expert consensus. This descriptive review of the available literature focuses on approach to therapy for acute intractable migraine in a pediatric population including outpatient, emergency department (ED), and inpatient management.
Collapse
Affiliation(s)
- Mohammed Alqahtani
- Division of Neurology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Rebecca Barmherzig
- Pediatric Headache Program, Division of Neurology, Children's Hospital of Philadelphia (CHOP), 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Ana Marissa Lagman-Bartolome
- Division of Neurology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. .,Centre for Headache, Women's College Hospital, University of Toronto, 76 Grenville Street, Toronto, Ontario, M5B1S2, Canada.
| |
Collapse
|
12
|
Michelsen-Correa S, Martin CF, Kirk AB. Evaluation of Fetal Exposures to Metals and Metalloids through Meconium Analyses: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041975. [PMID: 33670707 PMCID: PMC7922990 DOI: 10.3390/ijerph18041975] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/29/2022]
Abstract
This paper surveys the existing scientific literature on metals concentrations in meconium. We examine some 32 papers that analyzed meconium for aluminum, arsenic, barium, calcium, chromium, copper, iron, lithium, magnesium, manganese, zinc, lead, mercury, manganese, molybdenum, nickel, phosphorus, lead, antimony, selenium, tin, vanadium, and zinc. Because of the lack of detail in the statistics it is not possible to do a rigorous meta-analysis. What stands out is that almost every study had subjects with seemingly large amounts of at least one of the metals. The significance of metals in meconium is not clear beyond an indication of exposure although some studies have correlated metals in meconium to a number of adverse outcomes. A number of outstanding questions have been identified that, if resolved, would greatly increase the utility of meconium analysis for assessment of long-term gestational metals exposures. Among these are questions of the developmental and long-term significance of metals detected in meconium, the kinetics and interactions among metals in maternal and fetal compartments and questions on best methods for meconium analyses.
Collapse
Affiliation(s)
- Stephani Michelsen-Correa
- AAAS Science & Technology Policy Fellow Hosted by EPA Office of Chemical Safety and Pollution Prevention, Biopesticides and Pollution Prevention Division, Washington, DC 20004, USA;
| | - Clyde F. Martin
- Department of Mathematics and Statistics, Texas Tech University, Lubbock, TX 79409, USA
- Correspondence:
| | - Andrea B. Kirk
- Department of Occupational and Environmental Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA;
| |
Collapse
|
13
|
Grazzi L, Toppo C, D’Amico D, Leonardi M, Martelletti P, Raggi A, Guastafierro E. Non-Pharmacological Approaches to Headaches: Non-Invasive Neuromodulation, Nutraceuticals, and Behavioral Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1503. [PMID: 33562487 PMCID: PMC7914516 DOI: 10.3390/ijerph18041503] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023]
Abstract
Significant side effects or drug interactions can make pharmacological management of headache disorders very difficult. Non-conventional and non-pharmacological treatments are becoming increasingly used to overcome these issues. In particular, non-invasive neuromodulation, nutraceuticals, and behavioral approaches are well tolerated and indicated for specific patient categories such as adolescents and pregnant women. This paper aims to present the main approaches reported in the literature in the management of headache disorders. We therefore reviewed the available literature published between 2010 and 2020 and performed a narrative presentation for each of the three categories (non-invasive neuromodulation, nutraceuticals, and behavioral therapies). Regarding non-invasive neuromodulation, we selected transcranial magnetic stimulation, supraorbital nerve stimulation, transcranial direct current stimulation, non-invasive vagal nerve stimulation, and caloric vestibular stimulation. For nutraceuticals, we selected Feverfew, Butterbur, Riboflavin, Magnesium, and Coenzyme Q10. Finally, for behavioral approaches, we selected biofeedback, cognitive behavioral therapy, relaxation techniques, mindfulness-based therapy, and acceptance and commitment therapy. These approaches are increasingly seen as a valid treatment option in headache management, especially for patients with medication overuse or contraindications to drug treatment. However, further investigations are needed to consider the effectiveness of these approaches also with respect to the long-term effects.
Collapse
Affiliation(s)
- Licia Grazzi
- UOC Neuroalgologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Claudia Toppo
- UOC Neurologia, Salute Pubblica e Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (C.T.); (M.L.); (A.R.); (E.G.)
| | - Domenico D’Amico
- UOC Neuroalgologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Matilde Leonardi
- UOC Neurologia, Salute Pubblica e Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (C.T.); (M.L.); (A.R.); (E.G.)
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, 00185 Rome, Italy;
| | - Alberto Raggi
- UOC Neurologia, Salute Pubblica e Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (C.T.); (M.L.); (A.R.); (E.G.)
| | - Erika Guastafierro
- UOC Neurologia, Salute Pubblica e Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (C.T.); (M.L.); (A.R.); (E.G.)
| |
Collapse
|
14
|
The effects of maternal body mass index and plurality on maternal and umbilical cord serum magnesium levels in preterm birth at less than 32 weeks of gestation. Obstet Gynecol Sci 2020; 64:62-72. [PMID: 33285044 PMCID: PMC7834761 DOI: 10.5468/ogs.20235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/21/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To evaluate the effects of maternal body mass index (BMI) and plurality on maternal and umbilical cord serum magnesium levels after antenatal magnesium sulfate treatment. METHODS This was a retrospective cohort analysis of 135 women treated with antenatal magnesium sulfate at less than 32 weeks of gestation between January 2012 and June 2018. Subjects were stratified into groups according to maternal BMI (group I [18.5-22.9 kg/m²], group II [23.0-24.9 kg/m²], and group III [≥25.0 kg/m²]) and plurality (singleton and twin). Univariable and multivariable analyses were performed to compare the umbilical cord serum magnesium levels between the groups. RESULTS Maternal serum magnesium levels were not significantly different between the maternal BMI groups and singleton and twin pregnancies. Umbilical cord serum magnesium levels were significantly different among the maternal BMI groups (3.3±1.2 mg/dL in group I, 3.3±1.2 mg/dL in group II, and 4.0±1.4 mg/dL in group III, P=0.003). The trend of increase in magnesium levels was statistically significant (P=0.001, Jonckheere-Terpstra test). Umbilical cord serum magnesium levels were not significantly different according to plurality. However, in the multivariable analysis, maternal BMI and plurality were not significantly associated with umbilical cord serum magnesium levels after adjusting for indication and total dose of magnesium sulfate treatment, gestational age at delivery, mode of delivery, neonatal sex, and birth weight. CONCLUSION Maternal BMI and plurality were not significantly associated with maternal or umbilical cord serum magnesium levels after exposure to antenatal magnesium sulfate treatment.
Collapse
|
15
|
Abstract
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.
Collapse
|
16
|
Shepherd E, Salam RA, Manhas D, Synnes A, Middleton P, Makrides M, Crowther CA. Antenatal magnesium sulphate and adverse neonatal outcomes: A systematic review and meta-analysis. PLoS Med 2019; 16:e1002988. [PMID: 31809499 PMCID: PMC6897495 DOI: 10.1371/journal.pmed.1002988] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/06/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is widespread, increasing use of magnesium sulphate in obstetric practice for pre-eclampsia, eclampsia, and preterm fetal neuroprotection; benefit for preventing preterm labour and birth (tocolysis) is unproven. We conducted a systematic review and meta-analysis to assess whether antenatal magnesium sulphate is associated with unintended adverse neonatal outcomes. METHODS AND FINDINGS CINAHL, Cochrane Library, LILACS, MEDLINE, Embase, TOXLINE, and Web of Science, were searched (inceptions to 3 September 2019). Randomised, quasi-randomised, and non-randomised trials, cohort and case-control studies, and case reports assessing antenatal magnesium sulphate for pre-eclampsia, eclampsia, fetal neuroprotection, or tocolysis, compared with placebo/no treatment or a different magnesium sulphate regimen, were included. The primary outcome was perinatal death. Secondary outcomes included pre-specified and non-pre-specified adverse neonatal outcomes. Two reviewers screened 5,890 articles, extracted data, and assessed risk of bias following Cochrane Handbook and RTI Item Bank guidance. For randomised trials, pooled risk ratios (RRs) or mean differences, with 95% confidence intervals (CIs), were calculated using fixed- or random-effects meta-analysis. Non-randomised data were tabulated and narratively summarised. We included 197 studies (40 randomised trials, 138 non-randomised studies, and 19 case reports), of mixed quality. The 40 trials (randomising 19,265 women and their babies) were conducted from 1987 to 2018 across high- (16 trials) and low/middle-income countries (23 trials) (1 mixed). Indications included pre-eclampsia/eclampsia (24 trials), fetal neuroprotection (7 trials), and tocolysis (9 trials); 18 trials compared magnesium sulphate with placebo/no treatment, and 22 compared different regimens. For perinatal death, no clear difference in randomised trials was observed between magnesium sulphate and placebo/no treatment (RR 1.01; 95% CI 0.92 to 1.10; 8 trials, 13,654 babies), nor between regimens. Eleven of 138 non-randomised studies reported on perinatal death. Only 1 cohort (127 babies; moderate to high risk of bias) observed an increased risk of perinatal death with >48 versus ≤48 grams magnesium sulphate exposure for tocolysis. No clear secondary adverse neonatal outcomes were observed in randomised trials, and a very limited number of possible adverse outcomes warranting further consideration were identified in non-randomised studies. Where non-randomised studies observed possible harms, often no or few confounders were controlled for (moderate to high risk of bias), samples were small (200 babies or fewer), and/or results were from subgroup analyses. Limitations include missing data for important outcomes across most studies, heterogeneity of included studies, and inclusion of published data only. CONCLUSIONS Our findings do not support clear associations between antenatal magnesium sulphate for beneficial indications and adverse neonatal outcomes. Further large, high-quality studies (prospective cohorts or individual participant data meta-analyses) assessing specific outcomes, or the impact of regimen, pregnancy, or birth characteristics on these outcomes, would further inform safety recommendations. PROSPERO: CRD42013004451.
Collapse
Affiliation(s)
- Emily Shepherd
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology,
Adelaide Medical School, University of Adelaide, Adelaide, South Australia,
Australia
- South Australian Health and Medical Research Institute, Adelaide, South
Australia, Australia
| | - Rehana A. Salam
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology,
Adelaide Medical School, University of Adelaide, Adelaide, South Australia,
Australia
- South Australian Health and Medical Research Institute, Adelaide, South
Australia, Australia
| | - Deepak Manhas
- University of British Columbia, Vancouver, British Columbia,
Canada
| | - Anne Synnes
- University of British Columbia, Vancouver, British Columbia,
Canada
| | - Philippa Middleton
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology,
Adelaide Medical School, University of Adelaide, Adelaide, South Australia,
Australia
- South Australian Health and Medical Research Institute, Adelaide, South
Australia, Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute, Adelaide, South
Australia, Australia
| | - Caroline A. Crowther
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology,
Adelaide Medical School, University of Adelaide, Adelaide, South Australia,
Australia
- Liggins Institute, University of Auckland, Auckland, New
Zealand
| |
Collapse
|
17
|
Abstract
Migraine affects 959 million people worldwide,1 with the highest prevalence being in women of childbearing age. The interplay between female hormones and migraine can be a challenging area to navigate since issues relating to pregnancy, contraception and the menopause are often out of the neurology comfort zone. This review aims to help the neurologist to manage women with migraine, from menarche to menopause.
Collapse
|
18
|
Kocylowski R, Grzesiak M, Gaj Z, Lorenc W, Bakinowska E, Barałkiewicz D, von Kaisenberg CS, Lamers Y, Suliburska J. Associations between the Level of Trace Elements and Minerals and Folate in Maternal Serum and Amniotic Fluid and Congenital Abnormalities. Nutrients 2019; 11:E328. [PMID: 30717440 PMCID: PMC6413094 DOI: 10.3390/nu11020328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 12/27/2022] Open
Abstract
Congenital birth defects may result in a critical condition affecting the baby, including severe fetal/neonatal handicap and mortality. Several studies have shown that genetic, nutritional, and environmental factors may have an impact on fetal development and neonatal health. The relevance of essential and toxic elements on fetal development has not yet been fully investigated, and the results of recent research indicate that these elements may be crucial in the assessment of the risk of malformations in neonates. We determined the association between essential and toxic elements and the level of folate in maternal serum (MS) and amniotic fluid (AF), along with neonatal abnormalities. A total of 258 pregnant Polish women in the age group of 17⁻42 years participated in this study. AF and MS were collected during vaginal delivery or during cesarean section. An inductively coupled plasma mass spectrometry technique was used to determine the levels of various elements in AF and MS. The results of this exploratory study indicate that the levels of essential and toxic elements are associated with fetal and newborn anatomical abnormalities and growth disorders.
Collapse
Affiliation(s)
- Rafal Kocylowski
- Department of Obstetrics, Perinatology and Gynecology, Polish Mother's Memorial Hospital Research Institute, ul. Rzgowska 281/289, 93-338 Lodz, Poland.
- PreMediCare New Med Medical Center, ul. Drużbickiego 13, 61-693 Poznan, Poland.
| | - Mariusz Grzesiak
- Department of Obstetrics, Perinatology and Gynecology, Polish Mother's Memorial Hospital Research Institute, ul. Rzgowska 281/289, 93-338 Lodz, Poland.
| | - Zuzanna Gaj
- Department of Obstetrics, Perinatology and Gynecology, Polish Mother's Memorial Hospital Research Institute, ul. Rzgowska 281/289, 93-338 Lodz, Poland.
- Scientific Laboratory of the Center of Medical Laboratory Diagnostics and Screening, Polish Mother's Memorial Hospital Research Institute, ul. Rzgowska 281/289, 93-338 Lodz, Poland.
| | - Wiktor Lorenc
- Department of Trace Element Analysis by Spectroscopy Method, Faculty of Chemistry, Adam Mickiewicz University in Poznan, ul. Umultowska 89b, 61-614 Poznan, Poland.
| | - Ewa Bakinowska
- Institute of Mathematics, Poznan University of Technology, ul. Piotrowo 3A, 60-965 Poznan, Poland.
| | - Danuta Barałkiewicz
- Department of Trace Element Analysis by Spectroscopy Method, Faculty of Chemistry, Adam Mickiewicz University in Poznan, ul. Umultowska 89b, 61-614 Poznan, Poland.
| | - Constantin S von Kaisenberg
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
| | - Yvonne Lamers
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
- British Columbia Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.
| | - Joanna Suliburska
- Institute of Human Nutrition and Dietetics, Poznan University of Life Sciences, Poznan, Poland, ul. Wojska Polskiego 31, 60-624 Poznan, Poland.
| |
Collapse
|
19
|
Hamilton KT, Robbins MS. Migraine Treatment in Pregnant Women Presenting to Acute Care: A Retrospective Observational Study. Headache 2018; 59:173-179. [PMID: 30403400 DOI: 10.1111/head.13434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess the acute treatment of pregnant women presenting to a hospital with migraine. BACKGROUND Migraine is a common problem in pregnancy; however, migraine treatment is challenging in pregnant women for fears of medication teratogenicity and lack of data in this population. To date, no study has directly explored physician practices for treatment of acute migraine in pregnant women. METHODS We conducted a retrospective chart review of medication administration for pregnant women who presented to an acute care setting with a migraine attack and received neurology consultation between 2009 and 2014. RESULTS We identified 72 pregnant women with migraine who were treated with pain medications. Fifty-one percent (37/72) were in the third trimester of pregnancy, 39% (28/72) in the second trimester, and 10% (7/72) in the first trimester. Thirty-two percent (23/72) had not tried any acute medications at home before coming to the hospital, and 47% (34/72) presented in status migrainosus. Patients received treatment in the hospital for a median of 23 hours (interquartile range = 5-45 hours). The most common medications prescribed were metoclopramide in 74% (53/72) of patients (95% confidence interval [CI] 62-82%) and acetaminophen in 69% (50/72) of patients (95% CI 58-79%). Metoclopramide was administered along with diphenhydramine in 81% (44/53) of patients (95% CI 71-91%). Acetaminophen was the most frequent medicine administered first (53%, 38/72). Patients were often treated with butalbital (35%, 25/72) or opioids (30%, 22/72), which were used as second- or third-line treatments in 29% of patients (20/72). Thirty-eight percent (27/72) received an intravenous (IV) fluid bolus, 24% received IV magnesium (17/72), and 6% (4/72) had peripheral nerve blocks performed. CONCLUSIONS While the majority of pregnant women with acute migraine received medications considered relatively safe in pregnancy, there was variation in treatment choice and sequence. Some acute medications considered potentially hazardous for fetal health and less effective for migraine (opioids and butalbital) were used frequently, whereas other treatments that may have low teratogenic risk (nerve blocks, IV fluid boluses, and triptans) were used less or not at all. These results indicate a need for developing guidelines and protocols to standardize acute treatment of migraine in pregnancy.
Collapse
Affiliation(s)
- Katherine T Hamilton
- Department of Neurology, Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Matthew S Robbins
- Department of Neurology, Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
20
|
el Demellawy D, Davila J, Shaw A, Nasr Y. Brief Review on Metabolic Bone Disease. Acad Forensic Pathol 2018; 8:611-640. [PMID: 31240061 PMCID: PMC6490580 DOI: 10.1177/1925362118797737] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/21/2018] [Indexed: 01/17/2023]
Abstract
Metabolic bone disease (MBD) is a broad term that describes a clinically heterogeneous group of diseases that are only united by a common denominator of an aberrant bone chemical milieu leading to a defective skeleton and bone abnormalities. From a forensic pathologist's perspective, MBDs create a challenging diagnostic dilemma in differentiating them from child abuse, particularly when the victim is an infant. Through this brief narrative review on MBD, bone pathophysiology and two relatively challenging pediatric MBDs will be discussed.
Collapse
Affiliation(s)
- Dina el Demellawy
- Dina el Demellawy MD PhD FRCPC, 401 Smyth Rd, Pathology Department, Ottawa ON K1H 8L1,
| | | | | | | |
Collapse
|
21
|
Vranković L, Aladrović J, Ljubić BB, Pipal I, Prvanović-Babić N, Mašek T, Stojević Z. Blood biochemical parameters of bone metabolism in cows and calves kept in a beef suckler system during the early postpartum period. Livest Sci 2018. [DOI: 10.1016/j.livsci.2018.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
22
|
Afridi SK. Current concepts in migraine and their relevance to pregnancy. Obstet Med 2018; 11:154-159. [PMID: 30574176 DOI: 10.1177/1753495x18769170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/01/2018] [Indexed: 12/12/2022] Open
Abstract
The prevalence of migraine in women of childbearing age is high, estimated at 24%. Migraine management during pregnancy and lactation can be challenging. Our understanding of the way in which medications affect the unborn fetus is still incomplete and the evidence is constantly changing with more recent emphasis on longitudinal studies and childhood development. The aim of this article is to describe the relationship between migraine and pregnancy and review the current evidence on treatment options in pregnancy and lactation.
Collapse
Affiliation(s)
- Shazia K Afridi
- Department of Neurology, Guy's and St Thomas' NHS Trust, London, UK
| |
Collapse
|
23
|
Yonetani N, Kaji T, Hichijo A, Nakayama S, Maeda K, Irahara M. Effect of prolonged hospitalization for threatened preterm labor on maternal and fetal vitamin D levels. J Obstet Gynaecol Res 2018; 44:1042-1048. [DOI: 10.1111/jog.13620] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 01/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Naoto Yonetani
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences; Tokushima University Graduate School; Tokushima Japan
| | - Takashi Kaji
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences; Tokushima University Graduate School; Tokushima Japan
| | - Atsuko Hichijo
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences; Tokushima University Graduate School; Tokushima Japan
| | - Soichiro Nakayama
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences; Tokushima University Graduate School; Tokushima Japan
| | - Kazuhisa Maeda
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences; Tokushima University Graduate School; Tokushima Japan
- General Perinatal Medical Center; Shikoku Medical Center for Children and Adults; Zentsuji Japan
| | - Minoru Irahara
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences; Tokushima University Graduate School; Tokushima Japan
| |
Collapse
|
24
|
Neonatal Effects of Maternal Magnesium Sulphate in Late Preterm and Term Pregnancies. J Obstet Gynaecol India 2017; 69:25-30. [PMID: 30814806 DOI: 10.1007/s13224-017-1074-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022] Open
Abstract
Aim To compare the clinical, obstetric and neonatal parameters between patients with > 34-week gestation having severe preeclampsia receiving magnesium sulphate and those with > 34-week gestation with preeclampsia but not receiving magnesium sulphate. Materials and Methods Single-centre prospective study studied 60 patients in each of the two groups. Magnesium sulphate was administered by Pritchard regimen as per standard protocol. Standard obstetric management was followed for both groups. In the severe preeclampsia/eclampsia group, maternal blood sample was analysed for serum magnesium levels. The duration of exposure, the amount of magnesium sulphate received and time elapsed between last dose of magnesium sulphate and delivery were all noted. Neonatal assessment was done. The various parameters including age, parity, blood pressure, mode of termination of pregnancy, NICU admission rate, incidence of hypotonia in the newborn and other neonatal parameters were tabulated and compared. Results The two groups were comparable with respect to age and parity. Need for induction of labour was higher in the group with severe preeclampsia/eclampsia. Rate of LSCS and birth weights were comparable between the two groups. NICU admission rate and incidence of hypotonia were higher in those who received magnesium sulphate. Amount of magnesium sulphate received and total duration of magnesium sulphate did not correlate with NICU admission rates. Conclusions Neonatal morbidity, in terms of higher NICU admission rates and hypotonia, is higher in patients receiving magnesium sulphate.
Collapse
|
25
|
Wells RE, Turner DP, Lee M, Bishop L, Strauss L. Managing Migraine During Pregnancy and Lactation. Curr Neurol Neurosci Rep 2016; 16:40. [PMID: 27002079 DOI: 10.1007/s11910-016-0634-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
While over half of women with migraine report improvement during pregnancy, having a history of migraine may increase the chance of negative health outcomes. The state of pregnancy increases the risk of several dangerous secondary headache disorders, especially those associated with hypertensive disorders of pregnancy, and providers need to know the red flags to diagnose and treat emergently. Non-pharmacological migraine treatments can be instituted in advance of pregnancy as many are considered the safest options during pregnancy, but understanding the safety of medications and dietary supplements ensures appropriate care for the refractory migraine patient. New controversy exists over the safety of several historically routine and safe migraine treatment options in pregnancy, such as magnesium, acetaminophen, ondansetron, and butalbital. While it is not clear if breastfeeding decreases the postpartum recurrence of migraine, understanding safe treatment options during lactation can allow women to continue breastfeeding while achieving migraine relief.
Collapse
Affiliation(s)
- Rebecca Erwin Wells
- Department of Neurology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Dana P Turner
- Department of Anesthesiology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Michelle Lee
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Laura Bishop
- Department of Neurology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Lauren Strauss
- Department of Neurology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| |
Collapse
|
26
|
Brookfield KF, Su F, Elkomy MH, Drover DR, Lyell DJ, Carvalho B. Pharmacokinetics and placental transfer of magnesium sulfate in pregnant women. Am J Obstet Gynecol 2016; 214:737.e1-9. [PMID: 26767791 DOI: 10.1016/j.ajog.2015.12.060] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/20/2015] [Accepted: 12/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Magnesium sulfate is one of the most commonly prescribed intravenous medications in obstetrics. Despite its widespread use, there are limited data about magnesium pharmacokinetics, and magnesium is prescribed empirically without dose adjustment for different indications. OBJECTIVE The aim of this study was to characterize the pharmacokinetics and placental transfer of magnesium sulfate in pregnant women and to determine key covariates that impact the pharmacokinetics. STUDY DESIGN This is a prospective pharmacokinetic cohort study of pregnant women who were prescribed magnesium sulfate for preeclampsia, preterm labor, or extreme prematurity. Women received a 4-g loading dose and 2 g/h maintenance dose as clinically indicated. Maternal blood samples were obtained before and at multiple time points during and after magnesium administration. Cord blood also was sampled at delivery. A population pharmacokinetic approach that used a nonlinear mixed-effects modeling was used to characterize magnesium disposition. RESULTS Pharmacokinetic profiles of 111 pregnant women were analyzed. Magnesium clearance was 3.98 L/h in preeclamptic women and 5.88 L/h non-preeclamptic women. Steady-state concentration of magnesium was 7.2 mg/dL in preeclamptic women compared with 5.1 mg/dL in non-preeclamptic women. Maternal weight significantly impacted time to steady state. The ratio of the mean umbilical vein magnesium level to the mean maternal serum magnesium level at the time of delivery was 0.94 ± 0.15. CONCLUSIONS The study accurately characterizes the pharmacokinetics of magnesium administered to pregnant women. Preeclamptic status and maternal weight significantly impact serum magnesium levels. This pharmacokinetic model could be applied to larger cohorts to help tailor magnesium treatment and account for these covariates.
Collapse
Affiliation(s)
- Kathleen F Brookfield
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA.
| | - Felice Su
- Department of Pediatric Critical Care, Stanford University School of Medicine, Stanford, CA
| | - Mohammed H Elkomy
- Department of Pharmaceutics and Industrial Pharmacy, Beni-Suef University, Egypt
| | - David R Drover
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA
| | - Deirdre J Lyell
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Brendan Carvalho
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
27
|
Elliott JP, Morrison JC, Bofill JA. Risks and Benefits of Magnesium Sulfate Tocolysis in Preterm Labor (PTL). AIMS Public Health 2016; 3:348-356. [PMID: 29546168 PMCID: PMC5690360 DOI: 10.3934/publichealth.2016.2.348] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/23/2016] [Indexed: 11/18/2022] Open
Abstract
The U.S. Food and Drug Administration issued a drug safety communication on 05/30/2013 recommending "against prolonged use of magnesium sulfate to stop preterm labor (PTL) due to bone changes in exposed babies." In September of 2013, The American Congress of Obstetrics and Gynecologists issued Committee Opinion No. 573 " Magnesium Sulfate Use in Obstetrics" , which supports the short term use of MgSO4 to prolong pregnancy (up to 48 hrs.) to allow for the administration of antenatal corticosteroids." Are these pronouncements by respected organizations short sighted and will potentially result in more harm than good? The FDA safety communication focuses on bone demineralization (a few cases with fractures) with prolonged administration of MgSO4 (beyond 5-7 days). It cites 18 case reports in the Adverse Event Reporting System with an average duration of magnesium exposure of 9.6 weeks (range 8-12 wks). Other epidemiologic studies showed transient changes in bone density which resolved in the short duration of follow up. Interestingly, the report fails to acknowledge the fact that these 18 fetuses were in danger of PTD and the pregnancy was prolonged by 9.6 weeks (e.g. extending 25 weeks to 34.6 wks), thus significantly reducing mortality and morbidity. Evidence does support the efficacy of MgSO4 as a tocolytic medication. The decision to use magnesium, the dosage to administer, the duration of use, and alternative therapies are physician judgments. These decisions should be made based on a reasonable assessment of the risks of the clinical situation (PTL) and the treatments available versus the benefits of significantly prolonging pregnancy.
Collapse
Affiliation(s)
- John P. Elliott
- Banner University Medical Center, Phoenix, 1111 East McDowell Road, Phoenix, AZ 85005
| | - John C. Morrison
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi, 39216
| | - James A. Bofill
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi, 39216
| |
Collapse
|
28
|
Neonatal transient hypophosphatemic hypercalciuric rickets in dizygous twins: A role for maternal alendronate therapy before pregnancy or antireflux medications? Arch Pediatr 2016; 23:957-62. [PMID: 27150561 DOI: 10.1016/j.arcped.2016.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/25/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Bisphosphonates (BP) are sometimes used in children and young women, but their use requires expertise and caution due to the relative lack of long-term efficacy and safety data. CLINICAL CASES We report on two dizygotic male twins with a past of mild prematurity who presented at the age of 2 months with moderate clinical craniotabes, hypophosphatemia, normal circulating calcium, severe hypercalciuria, and low parathyroid hormone levels. Following supplementation with oral phosphorus and native vitamin D, the clinical and biological abnormalities disappeared within 2 months. Since the twins were dizygotic and were identical in terms of clinical presentation and progression, the only likely explanation for these transient mineral abnormalities was prenatal or neonatal exposure to a toxic agent. Taking into account their medical past, two drugs were possibly involved: either oral alendronate that their mother had received before pregnancy for misdiagnosed osteoporosis or antireflux medications, or both. DISCUSSION We believe that these two cases could correspond to the first description of a potential mother-to-fetus transmission of alendronate, inducing early and transient hypophosphatemic rickets, the clinical picture being worsened by the antireflux drugs impairing intestinal phosphate absorption. For pediatric rheumatologists, this raises the question of more clearly defining the indications for BP in female children and teenagers; for rheumatologists, this also demonstrates the importance of correctly diagnosing osteoporosis and not using BP off-label, especially in women of child-bearing age.
Collapse
|
29
|
Farsinejad-Marj M, Saneei P, Esmaillzadeh A. Dietary magnesium intake, bone mineral density and risk of fracture: a systematic review and meta-analysis. Osteoporos Int 2016; 27:1389-1399. [PMID: 26556742 DOI: 10.1007/s00198-015-3400-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/03/2015] [Indexed: 01/14/2023]
Abstract
Dietary magnesium intake has been related to osteoporosis and risk of fractures in earlier studies; however, findings were conflicting. This meta-analysis indicated that high magnesium intake was not associated with increased risk of fracture; however, a positive marginally significant correlation was found between magnesium intake and bone mineral density (BMD) in total hip as well as in femoral neck. Although there is some evidence on the association between magnesium intake, BMD and fractures, no previous study has summarized findings in this regard. We aimed to systematically review the current evidence on this association and to perform a meta-analysis of observational studies. We searched MEDLINE, Scopus, EMBASE and Google Scholar up to January 2015 for studies that examined the relationship between magnesium intake and BMD or fracture. Studies that had reported correlation coefficients between magnesium intake and BMD or those that reported odds ratios (ORs) or relative risks (RRs) for risk of fracture in different sites were included. In total, 12 studies were included in the meta-analysis. We found that high intakes of magnesium were not significantly associated with risk of total hip fracture (summary effect size 1.92; 95 % CI 0.81, 4.55) or total fractures (1.01; 0.94-1.07). Combining four effect sizes, a positive marginally significant correlation was observed between magnesium intake and total BMD (pooled r 0.16; 95 % CI 0.001, 032). Based on nine effect sizes, we found a marginally significant association between magnesium intake and femoral neck BMD (0.14; 0.001, 0.28). However, no significant correlation was found between magnesium intake and BMD in lumbar spine (0.09; -0.01, 0.19). We found that high intakes of magnesium were not associated with increased risk of hip and total fractures. There was a positive marginally significant correlation between magnesium intake and BMD in femoral neck and total hip. No significant correlations were observed between magnesium intake and BMD in lumbar spine.
Collapse
Affiliation(s)
- M Farsinejad-Marj
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, PO Box 81745-151, Iran
| | - P Saneei
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, PO Box 81745-151, Iran
- Students' Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Esmaillzadeh
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, PO Box 81745-151, Iran.
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
30
|
|
31
|
Nakazawa H, Uchida A, Minamitani T, Makishi A, Takamatsu Y, Kiyoshi K, Samoto T, Funakoshi T. Factors affecting maternal serum magnesium levels during long-term magnesium sulfate tocolysis in singleton and twin pregnancy. J Obstet Gynaecol Res 2015; 41:1178-84. [PMID: 25857633 DOI: 10.1111/jog.12690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 11/29/2014] [Accepted: 01/06/2015] [Indexed: 11/30/2022]
Abstract
AIM Our aim was to determine factors that affect maternal serum magnesium (Mg) levels, to help ensure the safety and efficacy of long-term magnesium sulfate (MgSO4 ) therapy for threatened preterm labor in singleton and twin pregnancies. MATERIAL AND METHODS We retrospectively and arbitrarily studied 100 patients (singleton pregnancy, n = 65; twin pregnancy, n = 35) who received i.v. MgSO4 for >48 h for tocolysis of threatened preterm labor. We used multiple regression analysis to investigate the functional relations between the candidate factors and maternal serum Mg levels. RESULTS MgSO4 was administered as a loading dose of 3 g for 1 h followed by a maintenance dose of 1.0-2.0 g/h. There were no maternal severe adverse events related to the elevated Mg levels in any of the subjects. The results of multiple regression analysis revealed that total dose of MgSO4 for 24 h before blood collection (g/day), total serum protein level (g/dL), serum total calcium level (mg/dL), serum creatinine level (mg/dL) and maternal bodyweight (kg) significantly affected maternal serum Mg levels in both singleton and twin pregnancies (all P-values were < 0.001). Gestational age (weeks) and period of MgSO4 administration (days) at blood collection had no significant effect in singleton or twin pregnancies. CONCLUSION Our study statistically shows that dose of MgSO4 , total serum protein level, serum total calcium level, serum creatinine level and maternal bodyweight are key factors to achieving safe and effective long-term tocolysis with MgSO4 in not only singleton but also twin pregnancies.
Collapse
Affiliation(s)
- Hiroshi Nakazawa
- Department of Obstetrics, Perinatal Medical Center, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Akiko Uchida
- Department of Obstetrics, Perinatal Medical Center, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Tomoyuki Minamitani
- Department of Obstetrics, Perinatal Medical Center, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Aya Makishi
- Department of Obstetrics, Perinatal Medical Center, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Yukou Takamatsu
- Department of Obstetrics, Perinatal Medical Center, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Kenji Kiyoshi
- Department of Obstetrics, Perinatal Medical Center, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Takashi Samoto
- Department of Obstetrics, Perinatal Medical Center, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Toru Funakoshi
- Department of Obstetrics, Perinatal Medical Center, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| |
Collapse
|
32
|
The use of intravenous magnesium in non-preeclamptic pregnant women: fetal/neonatal neuroprotection. Arch Gynecol Obstet 2014; 291:969-75. [DOI: 10.1007/s00404-014-3581-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
|
33
|
Campbell SC, Stockmann C, Balch A, Clark EAS, Kamyar M, Varner M, Korgenski EK, Bonkowsky JL, Spigarelli MG, Sherwin CMT. Intrapartum magnesium sulfate and the potential for cardiopulmonary drug-drug interactions. Ther Drug Monit 2014; 36:544-8. [PMID: 24487252 PMCID: PMC4101045 DOI: 10.1097/ftd.0000000000000050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study sought to determine the frequency of possible cardiopulmonary drug-drug interactions among pregnant women who received intrapartum magnesium sulfate (MgSO4). METHODS Pregnant women admitted to an Intermountain Healthcare facility between January 2009 and October 2011 were studied, if they received 1 or more doses of MgSO4. Concomitant medications were electronically queried from an electronic health records system. Adverse events were identified using administrative discharge codes. The frequency of cardiopulmonary drug-drug interactions was compared among women who did, and did not, receive aminoglycoside antibiotics, antacids/laxatives, calcium channel blockers, corticosteroids, diuretics, neuromuscular blocking agents, and vitamin D analogs, all of which were contraindicated for patients receiving MgSO4. RESULTS Overall, 683 women received intrapartum MgSO4 during the study period. A total of 219 MgSO4 potentially interacting drugs were identified among 155 (23%) unique patients. The most commonly identified potentially interacting agents included calcium channel blockers (26%), diuretics (25%), and antacids/laxatives (19%). Longer hospital stays were significantly associated with increasing numbers of MgSO4 interacting drugs (P < 0.001). Three of 53 (6%) women who received furosemide experienced a cardiac arrest, compared with 0 of 618 (0%) women who did not receive furosemide (Fisher exact test, P < 0.001). CONCLUSIONS Intrapartum administration of drugs that interact with MgSO4 is common and associated with prolonged hospital stays and potentially cardiopulmonary drug-drug interactions. Caution is warranted when prescribing MgSO4 in combination with known interacting medications.
Collapse
Affiliation(s)
- Sarah C Campbell
- *Division of Clinical Pharmacology, Department of Pediatrics, University of Utah; †Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine; ‡Intermountain Healthcare, Women and Newborns Clinical Program; §Intermountain Healthcare, Pediatric Clinical Program; and ¶Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Zhang L, Yang C, Li J, Zhu Y, Zhang X. High extracellular magnesium inhibits mineralized matrix deposition and modulates intracellular calcium signaling in human bone marrow-derived mesenchymal stem cells. Biochem Biophys Res Commun 2014; 450:1390-5. [PMID: 25010642 DOI: 10.1016/j.bbrc.2014.07.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 07/01/2014] [Indexed: 02/07/2023]
Abstract
Mesenchymal stem cells (MSCs) have the potential to differentiate into several cell types and provide an attractive source of autologous cells for regenerative medicine. However, their cellular biology is not fully understood. Similar to Ca(2+), extracellular Mg(2+) plays an important role in the functions of the skeletal system. Here, we examined the effects of extracellular Mg(2+) on the deposition of calcium phosphate matrix and Ca(2+) signaling with or without ATP stimulation in human bone marrow-derived mesenchymal stem cells (hBMSCs). We found that high extracellular Mg(2+) concentration ([Mg(2+)]e) inhibited extracellular matrix mineralization in hBMSCs in vitro. hBMSCs also produced a dose-dependent decrease in the frequency of calcium oscillations during [Mg(2+)]e elevation with a slight suppression on oscillation amplitude. In addition, spontaneous ATP release was inhibited under high [Mg(2+)]e levels and exogenous ATP addition stimulated oscillation reappear. Taken together, our results indicate that high [Mg(2+)]e modulates calcium oscillations via suppression of spontaneous ATP release and inactivates purinergic receptors, resulting in decreased extracellular mineralized matrix deposition in hBMSCs. Therefore, the high magnesium environment created by the rapid corrosion of Mg alloys may result in the dysfunction of calcium-dependent physiology processes and be disadvantageous to hBMSCs physiology.
Collapse
Affiliation(s)
- Li Zhang
- Department of Orthopedics, Tenth People's Hospital, Shanghai Tong Ji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, People's Republic of China; The First Clinical Medical College, Nanjing Medical University, 140 Hanzhong Road, Nanjing 210029, People's Republic of China
| | - Chunxi Yang
- Department of Orthopedics, Tenth People's Hospital, Shanghai Tong Ji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, People's Republic of China.
| | - Jiao Li
- The Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), Shanghai 200025, People's Republic of China
| | - Yuchang Zhu
- Department of Orthopedics, Tenth People's Hospital, Shanghai Tong Ji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, People's Republic of China
| | - Xiaoling Zhang
- The Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), Shanghai 200025, People's Republic of China.
| |
Collapse
|
35
|
Miller M, Ward T, Stolfi A, Ayoub D. Overrepresentation of multiple birth pregnancies in young infants with four metabolic bone disorders: further evidence that fetal bone loading is a critical determinant of fetal and young infant bone strength. Osteoporos Int 2014; 25:1861-73. [PMID: 24696017 DOI: 10.1007/s00198-014-2690-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/12/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED The frequency of multiple birth pregnancies, mostly twin pregnancies, was overrepresented in four different groups of young infants with fractures and bone abnormalities. This finding suggests that fetal bone loading through fetal movement is an important determinant of fetal bone formation and its resultant bone strength. INTRODUCTION It has been suggested that intrauterine confinement related to the multiple birth pregnancy (MBP) may lead to an increased risk for fragility fractures in young infants as a result of decreased fetal bone loading. METHODS To objectively test this idea, the frequency of MBPs was evaluated in five groups of young infants with bone disorders: (1) infants exposed to prolonged in utero exposure to magnesium, (2) infants with dietary copper deficiency, (3) infants with rickets from vitamin D deficiency, (4) infants with temporary brittle bone disease, and (5) infants with multiple unexplained fractures in which child abuse was the most likely diagnosis. RESULTS Compared to a control group and controlled for preterm birth, there was a statistically greater frequency of MBPs in each group. CONCLUSIONS The results of this study suggest the following: (a) The overrepresentation of MBPs (95 % twins) in these five groups indicates that fetal bone loading is a critical determinant of fetal bone strength; (b) fetal and young infant bone strength is a multifactorial characteristic; and (c) infants from MBPs are at increased risk for fragility fractures during the first 12 months of life, and thus may be mistakenly diagnosed as victims of child abuse.
Collapse
Affiliation(s)
- M Miller
- Departments of Pediatrics, Ob/Gyn, and Biomedical Engineering, Wright State University Boonshoft School of Medicine, Dayton, OH, USA,
| | | | | | | |
Collapse
|
36
|
Abstract
Fetal or neonatal brain injury can result in lifelong neurologic disability. The most significant risk factor for perinatal brain injury is prematurity; however, in absolute numbers, full-term infants represent the majority of affected children. Research on strategies to prevent or mitigate the impact of perinatal brain injury ("perinatal neuroprotection") has established the mitigating roles of magnesium sulfate administration for preterm infants and therapeutic hypothermia for term infants with suspected perinatal brain injury. Banked umbilical cord blood, erythropoietin, and a number of other agents that may improve neuronal repair show promise for improving outcomes following perinatal brain injury in animal models. Other preventative strategies include delayed umbilical cord clamping in preterm infants and progesterone in women with prior preterm birth or short cervix and avoidance of infections. Despite these advances, we have not successfully decreased the rate of preterm birth, nor are we able to predict term infants at risk of hypoxic brain injury in order to intervene prior to the hypoxic event. Further, we lack the ability to modulate the sequelae of neuronal cell insults or the ability to repair brain injury after it has been sustained. As a consequence, despite exciting advances in the field of perinatal neuroprotection, perinatal brain injury still impacts thousands of newborns each year with significant long-term morbidity and mortality.
Collapse
Affiliation(s)
- Kirsten E. Salmeen
- 513 Parnassus Avenue, Room HSE-1634, Box 0556, San Francisco, CA 94143-0556USA
| | - Angie C. Jelin
- 106 Irving Street, NW, Room POB 108, Washington, DC 20010USA
| | - Mari-Paule Thiet
- 505 Parnassus Avenue, Moffitt 1478, Box 0132, San Francisco, CA 94143-0132USA
| |
Collapse
|
37
|
|
38
|
Castiglioni S, Cazzaniga A, Albisetti W, Maier JAM. Magnesium and osteoporosis: current state of knowledge and future research directions. Nutrients 2013; 5:3022-33. [PMID: 23912329 PMCID: PMC3775240 DOI: 10.3390/nu5083022] [Citation(s) in RCA: 256] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 07/14/2013] [Accepted: 07/22/2013] [Indexed: 01/25/2023] Open
Abstract
A tight control of magnesium homeostasis seems to be crucial for bone health. On the basis of experimental and epidemiological studies, both low and high magnesium have harmful effects on the bones. Magnesium deficiency contributes to osteoporosis directly by acting on crystal formation and on bone cells and indirectly by impacting on the secretion and the activity of parathyroid hormone and by promoting low grade inflammation. Less is known about the mechanisms responsible for the mineralization defects observed when magnesium is elevated. Overall, controlling and maintaining magnesium homeostasis represents a helpful intervention to maintain bone integrity.
Collapse
Affiliation(s)
- Sara Castiglioni
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Via GB Grassi 74, Milan I-20157, Italy; E-Mails: (S.C.); (A.C.)
| | - Alessandra Cazzaniga
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Via GB Grassi 74, Milan I-20157, Italy; E-Mails: (S.C.); (A.C.)
| | - Walter Albisetti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Commenda 10, Milan I-20157, Italy; E-Mail:
| | - Jeanette A. M. Maier
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Via GB Grassi 74, Milan I-20157, Italy; E-Mails: (S.C.); (A.C.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-02-5031-9648; Fax: +39-02-5031-9659
| |
Collapse
|
39
|
Nehra D, Carlson SJ, Fallon EM, Kalish B, Potemkin AK, Gura KM, Simpser E, Compher C, Puder M. A.S.P.E.N. clinical guidelines: nutrition support of neonatal patients at risk for metabolic bone disease. JPEN J Parenter Enteral Nutr 2013; 37:570-98. [PMID: 23685349 DOI: 10.1177/0148607113487216] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Premature infants are at increased risk for metabolic bone disease, with resulting delayed bone growth, osteopenia, and rickets. METHOD A systematic review of the best available evidence to answer a series of questions regarding neonatal patients at risk of metabolic bone disease receiving parenteral or enteral nutrition was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development and Evaluation working group. A consensus process was used to develop the clinical guideline recommendations prior to external and internal review and approval by the American Society for Parenteral and Enteral Nutrition Board of Directors. QUESTIONS (1) What maternal risk factors predispose the neonate to metabolic bone disease? (2) What is the optimal type of feeding to promote neonatal bone health? (3) When and how should vitamin D supplements be administered? (4) Does parenteral nutrition (PN) predispose a neonate to metabolic bone disease, and if so, are there PN formulation recommendations to minimize this risk?
Collapse
Affiliation(s)
- Deepika Nehra
- Department of Surgery and The Vascular Biology Program, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Boriboonhirunsarn D, Lertbunnaphong T, Suwanwanich M. Correlation of magnesium levels in cord blood and maternal serum among pre-eclamptic pregnant women treated with magnesium sulfate. J Obstet Gynaecol Res 2011; 38:247-52. [PMID: 22136102 DOI: 10.1111/j.1447-0756.2011.01702.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM The aim of this study was to determine the correlation between cord blood and maternal serum magnesium levels among pre-eclamptic pregnant women treated with magnesium sulfate. MATERIALS AND METHODS A total of 36 pregnant women, >28weeks' gestation, diagnosed with pre-eclampsia and treated with magnesium sulfate (MgSO(4) ), were enrolled. Maternal and umbilical cord blood samples were obtained immediately after delivery and sent for determination of magnesium and calcium levels. RESULTS Mean maternal age was 27.4±6.4years and mean gestational age was 38.1±1.8weeks. Most were diagnosed with pre-eclampsia (94.5%), others had HELLP syndrome. Mean total MgSO(4) the women received was 14.4±6.0g and mean duration of treatment was 5.1±3.3h. Mean maternal serum and cord blood magnesium levels were 2.2±0.4 and 1.8±0.3mmol/L, respectively. Maternal magnesium and calcium levels showed significant positive correlation with their levels in cord blood (P<0.001). Significant positive correlation was found between total dose as well as duration of MgSO4 and maternal and cord blood magnesium levels (P<0.001) but was inversely correlated with maternal and cord blood calcium levels. CONCLUSIONS Maternal serum magnesium and calcium levels were correlated with cord blood levels in pre-eclamptic pregnant women who received MgSO4 therapy.
Collapse
Affiliation(s)
- Dittakarn Boriboonhirunsarn
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | |
Collapse
|