American journal of obstetrics and gynecology · 2026
Antenatal magnesium sulfate prior to very preterm birth in routine care is associated with increased survival without cerebral palsy.
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Shepherd Emily, Rumbold Alice, McIntyre Sarah, Goldsmith Shona, Karim Tasneem, Keir Amy, Poprzeczny Amanda, Hunt Rod W, Badawi Nadia, McKinlay Christopher J D, Crowther Caroline A, Yelland Lisa N, Australian and New Zealand Neonatal Network (ANZNN)
Аннотация
BACKGROUND: In the last 2 decades, based on systematic reviews of randomized controlled trials, antenatal magnesium sulfate has been variably implemented internationally for fetal neuroprotection.
OBJECTIVE: Our objective was to assess the effects of magnesium sulfate exposure prior to extremely preterm/low birthweight birth on survival without cerebral palsy or moderate to severe functional impairment in an Australian and New Zealand cohort.
STUDY DESIGN: This population-based retrospective cohort study, using data from the Australian and New Zealand Neonatal Network registry, included neonates born from January 1, 2012 through December 31, 2020 at <30 weeks' gestation; due to data availability, 2 to 3 years of follow-up was restricted to those born through December 31, 2017 at <28 weeks' gestation and/or weighing <1000 g. Analyses were performed using logistic regression with adjustment for potential confounding.
RESULTS: The cohort included 16,582 neonates for outcomes to hospital discharge. For primary outcomes at 2 to 3 years, among 6763 infants (4353 [64%] exposed to magnesium sulfate), exposure to magnesium sulfate was associated with a reduced risk of death or cerebral palsy (adjusted relative risk, 0.83; 95% confidence interval, 0.74-0.93) and of death or moderate to severe functional impairment (adjusted relative risk, 0.88; 95% confidence interval, 0.81-0.97). A clear reduction in cerebral palsy was observed for children born from singleton pregnancies (adjusted relative risk, 0.68; 95% confidence interval, 0.47-0.98). When multiples were included, the reduced risk of cerebral palsy was not statistically significant (adjusted relative risk, 0.78; 95% confidence interval, 0.59-1.05).
CONCLUSION: Our large, binational study demonstrates real-world benefits of exposure to magnesium sulfate prior to extremely preterm and/or low birthweight birth, including increased survival without cerebral palsy or moderate to severe functional impairment, strongly supporting ongoing and enhanced implementation.
OBJECTIVE: Our objective was to assess the effects of magnesium sulfate exposure prior to extremely preterm/low birthweight birth on survival without cerebral palsy or moderate to severe functional impairment in an Australian and New Zealand cohort.
STUDY DESIGN: This population-based retrospective cohort study, using data from the Australian and New Zealand Neonatal Network registry, included neonates born from January 1, 2012 through December 31, 2020 at <30 weeks' gestation; due to data availability, 2 to 3 years of follow-up was restricted to those born through December 31, 2017 at <28 weeks' gestation and/or weighing <1000 g. Analyses were performed using logistic regression with adjustment for potential confounding.
RESULTS: The cohort included 16,582 neonates for outcomes to hospital discharge. For primary outcomes at 2 to 3 years, among 6763 infants (4353 [64%] exposed to magnesium sulfate), exposure to magnesium sulfate was associated with a reduced risk of death or cerebral palsy (adjusted relative risk, 0.83; 95% confidence interval, 0.74-0.93) and of death or moderate to severe functional impairment (adjusted relative risk, 0.88; 95% confidence interval, 0.81-0.97). A clear reduction in cerebral palsy was observed for children born from singleton pregnancies (adjusted relative risk, 0.68; 95% confidence interval, 0.47-0.98). When multiples were included, the reduced risk of cerebral palsy was not statistically significant (adjusted relative risk, 0.78; 95% confidence interval, 0.59-1.05).
CONCLUSION: Our large, binational study demonstrates real-world benefits of exposure to magnesium sulfate prior to extremely preterm and/or low birthweight birth, including increased survival without cerebral palsy or moderate to severe functional impairment, strongly supporting ongoing and enhanced implementation.