Magnesium sulphate and other anticonvulsants for women with pre-eclampsia.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 21069663 · doi:10.1002/14651858.CD000025.pub2
What was done
A systematic review and meta-analysis of randomised trials comparing anticonvulsants (primarily magnesium sulphate) with placebo, no anticonvulsant, or alternative drugs for women with pre-eclampsia. Searches were conducted in the Cochrane Pregnancy and Childbirth Group's Trials Register and CENTRAL up to June 2010. Two authors independently assessed trial quality and extracted data.
What was found
Across 15 included trials: - Magnesium sulphate vs placebo/no anticonvulsant (6 trials, 11,444 women): magnesium sulphate reduced eclampsia risk (RR 0.41, 95% CI 0.29 to 0.58; NNTB 100, 95% CI 50 to 100) and placental abruption (RR 0.64, 95% CI 0.50 to 0.83; NNTB 100), with a non-significant reduction in maternal death (RR 0.54, 95% CI 0.26 to 1.10). There was no clear difference in serious maternal morbidity (RR 1.08, 95% CI 0.89 to 1.32) or stillbirth/neonatal death (RR 1.04, 95% CI 0.93 to 1.15). Caesarean delivery was slightly increased (RR 1.05, 95% CI 1.01 to 1.10). Side effects (chiefly flushing) were higher (24% vs 5%; RR 5.26, 95% CI 4.59 to 6.03; NNTH 6). - Long-term follow-up (1 trial): no clear difference in maternal mortality at median 26 months (3,375 women; RR 1.79, 95% CI 0.71 to 4.53) or child death at 18 months (3,283 children; RR 1.02, 95% CI 0.57 to 1.84) or neurosensory disability (RR 0.77, 95% CI 0.38 to 1.58). - Direct comparisons: magnesium sulphate was superior for preventing eclampsia compared with phenytoin (3 trials, 2,291 women; RR 0.08, 95% CI 0.01 to 0.60) and nimodipine (1 trial, 1,650 women; RR 0.33, 95% CI 0.14 to 0.77).
Why it matters
This review provides robust evidence supporting magnesium sulphate as the primary prophylactic anticonvulsant to prevent eclampsia in women with pre-eclampsia.
Limits
Long-term maternal and pediatric follow-up data were available from only a single trial. The reduction in maternal mortality did not reach statistical significance, and minor side effects occurred in roughly one quarter of treated women.
Cited by
- supports Intravenous magnesium is used clinically to treat preeclampsia and preterm labor.