Magnesium sulfate administered intravenously to a pregnant woman who is about to deliver a premature infant is an unconfirmed, ineffective and potentially fatal treatment, David Grimes and Kavita Nanda of Family Health International write in an Obstetrics and Gynecology commentary published in the October issue of the journal, the Washington Post reports. Infusions of magnesium sulfate, or Epsom salts, commonly are administered to pregnant women between 26 and 34 weeks' gestation for about 48 hours to delay contractions and allow the injection of steroids, which increases the rate of fetal lung development. According to the Post, magnesium sulfate can cause side effects that include blurred vision, burning sensations, headaches, nausea and "profound lethargy." In some cases, it can lead to pulmonary edema, a condition in which the lungs fill with liquid, the Post reports. The commentary is a response to a study conducted by the Cochrane Collaboration that reviewed 23 clinical trials conducted worldwide involving 2,000 pregnant women who had received the drug. The study finds that the use of magnesium sulfate did not reduce preterm labor and that more infants died as a result of administering drug compared with the control group. Grimes and Nanda estimate that about 120,000 U.S. women receive magnesium sulfate annually and that its use might be associated with 1,900 to 4,800 fetal deaths annually in the country. According to Grimes, physicians seeking to delay premature contractions that can prompt labor should use a calcium channel blocker such as nifedipine, which has been proven effective.

Comments
The use of magnesium sulfate is a "North American anomaly" that is predicated on "good hopes and good wishes rather than good data," Grimes said. For many physicians, "there is pressure to use [magnesium sulfate] from patients, as well as peer pressure" from other doctors, Gary Cunningham, a professor at the University of Texas Southwestern Medical Center, said. He added that the drug has a "powerful constituency" and is an effective treatment for other conditions -- such as preeclampsia, eclampsia or pregnancy-induced hypertension. Michael Gallagher, a maternal and fetal medicine specialist at Shady Grove Adventist and Holy Cross hospitals, said, "There is current practice (to use the drug) that is the community standard." He added that use of magnesium sulfate is a safe and viable option in some cases and is not an ineffective and dangerous drug (Boodman, Washington Post, 10/10).

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