Use of magnesium sulfate before 32 weeks of gestation: A European population-based cohort study

H. T. Wolf; T. Weber; A. Piedvache; S. Schmidt; M. Norman; J. Zeitlin; The EPICE Research Group; E. Martens; G. Martens; P. Van Reempts; K. Boerch; A. Hasselager; L. Huusom; O. Pryds; T. Weber; L. Toome; H. Varendi; P. Y. Ancel; B. Blondel; A. Burguet; P. H. Jarreau; P. Truffert; R. F. Maier; B. Misselwitz; S. Schmidt; L. Gortner; D. Baronciani; G. Gargano; R. Agostino; D. DiLallo; F. Franco; V. Carnielli; M. Cuttini; C. Koopman-Esseboom; A. Van Heijst; J. Nijman; J. Gadzinowski; J. Mazela; L. M. Graça; M. C. MacHado; C. Rodrigues; T. Rodrigues; H. Barros; A. K. Bonamy; M. Norman; E. Wilson; E. Boyle; E. S. Draper; B. N. Manktelow; A. C. Fenton

doi:10.1136/bmjopen-2016-013952

Use of magnesium sulfate before 32 weeks of gestation: A European population-based cohort study

H. T. Wolf^*, T. Weber, A. Piedvache, S. Schmidt, M. Norman, J. Zeitlin, The EPICE Research Group, E. Martens, G. Martens, P. Van Reempts, K. Boerch, A. Hasselager, L. Huusom, O. Pryds, T. Weber, L. Toome, H. Varendi, P. Y. Ancel, B. Blondel, A. BurguetP. H. Jarreau, P. Truffert, R. F. Maier, B. Misselwitz, S. Schmidt, L. Gortner, D. Baronciani, G. Gargano, R. Agostino, D. DiLallo, F. Franco, V. Carnielli, M. Cuttini, C. Koopman-Esseboom, A. Van Heijst, J. Nijman, J. Gadzinowski, J. Mazela, L. M. Graça, M. C. MacHado, C. Rodrigues, T. Rodrigues, H. Barros, A. K. Bonamy, M. Norman, E. Wilson, E. Boyle, E. S. Draper, B. N. Manktelow, A. C. Fenton

^*Corresponding author for this work

Department of Clinical Medicine

10 Citations (Scopus)

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Abstract

Objectives: The use of magnesium sulfate (MgSO₄) in European obstetric units is unknown. We aimed to describe reported policies and actual use of MgSO₄ in women delivering before 32 weeks of gestation by indication. Methods: We used data from the European Perinatal Intensive Care in Europe (EPICE) population-based cohort study of births before 32 weeks of gestation in 19 regions in 11 European countries. Data were collected from April 2011 to September 2012 from medical records and questionnaires. The study population comprised 720 women with severe preeclampsia, eclampsia or HELLP and 3658 without preeclampsia delivering from 24 to 31 weeks of gestation in 119 maternity units with 20 or more very preterm deliveries per year. Results: Among women with severe pre-eclampsia, eclampsia or HELLP, 255 (35.4%) received MgSO₄ before delivery. 41% of units reported use of MgSO₄ whenever possible for pre-eclampsia and administered MgSO₄ more often than units reporting use sometimes. In women without pre-eclampsia, 95 (2.6%) received MgSO₄. 9 units (7.6%) reported using MgSO₄ for fetal neuroprotection whenever possible. In these units, the median rate of MgSO₄ use for deliveries without severe pre-eclampsia, eclampsia and HELLP was 14.3%. Only 1 unit reported using MgSO₄ as a first-line tocolytic. Among women without preeclampsia, MgSO₄ use was not higher in women hospitalised before delivery for preterm labour. Conclusions: Severe pre-eclampsia, eclampsia or HELLP are not treated with MgSO₄ as frequently as evidence-based medicine recommends. MgSO₄ is seldom used for fetal neuroprotection, and is no longer used for tocolysis. To continuously lower morbidity, greater attention to use of MgSO₄ is needed.

Original language	English
Article number	e013952
Journal	BMJ Open
Volume	7
Number of pages	13
ISSN	2044-6055
DOIs	https://doi.org/10.1136/bmjopen-2016-013952
Publication status	Published - 2017

Keywords

PREVENTIVE MEDICINE

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Use of magnesium sulfate before 32 weeks of gestation: a European population-based cohort studyFinal published version, 1.15 MBLicence: CC BY-NC

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Wolf, H. T., Weber, T., Piedvache, A., Schmidt, S., Norman, M., Zeitlin, J., The EPICE Research Group, Martens, E., Martens, G., Van Reempts, P., Boerch, K., Hasselager, A., Huusom, L., Pryds, O., Weber, T., Toome, L., Varendi, H., Ancel, P. Y., Blondel, B., ... Fenton, A. C. (2017). Use of magnesium sulfate before 32 weeks of gestation: A European population-based cohort study. BMJ Open, 7, [e013952]. https://doi.org/10.1136/bmjopen-2016-013952

Wolf, HT, Weber, T, Piedvache, A, Schmidt, S, Norman, M, Zeitlin, J, The EPICE Research Group, Martens, E, Martens, G, Van Reempts, P, Boerch, K, Hasselager, A, Huusom, L, Pryds, O, Weber, T, Toome, L, Varendi, H, Ancel, PY, Blondel, B, Burguet, A, Jarreau, PH, Truffert, P, Maier, RF, Misselwitz, B, Schmidt, S, Gortner, L, Baronciani, D, Gargano, G, Agostino, R, DiLallo, D, Franco, F, Carnielli, V, Cuttini, M, Koopman-Esseboom, C, Van Heijst, A, Nijman, J, Gadzinowski, J, Mazela, J, Graça, LM, MacHado, MC, Rodrigues, C, Rodrigues, T, Barros, H, Bonamy, AK, Norman, M, Wilson, E, Boyle, E, Draper, ES, Manktelow, BN & Fenton, AC 2017, 'Use of magnesium sulfate before 32 weeks of gestation: A European population-based cohort study', BMJ Open, vol. 7, e013952. https://doi.org/10.1136/bmjopen-2016-013952

@article{bb7fd5481e3e4e4a8d9fad2da6075e6e,

title = "Use of magnesium sulfate before 32 weeks of gestation: A European population-based cohort study",

abstract = "Objectives: The use of magnesium sulfate (MgSO4) in European obstetric units is unknown. We aimed to describe reported policies and actual use of MgSO4 in women delivering before 32 weeks of gestation by indication. Methods: We used data from the European Perinatal Intensive Care in Europe (EPICE) population-based cohort study of births before 32 weeks of gestation in 19 regions in 11 European countries. Data were collected from April 2011 to September 2012 from medical records and questionnaires. The study population comprised 720 women with severe preeclampsia, eclampsia or HELLP and 3658 without preeclampsia delivering from 24 to 31 weeks of gestation in 119 maternity units with 20 or more very preterm deliveries per year. Results: Among women with severe pre-eclampsia, eclampsia or HELLP, 255 (35.4%) received MgSO4 before delivery. 41% of units reported use of MgSO4 whenever possible for pre-eclampsia and administered MgSO4 more often than units reporting use sometimes. In women without pre-eclampsia, 95 (2.6%) received MgSO4. 9 units (7.6%) reported using MgSO4 for fetal neuroprotection whenever possible. In these units, the median rate of MgSO4 use for deliveries without severe pre-eclampsia, eclampsia and HELLP was 14.3%. Only 1 unit reported using MgSO4 as a first-line tocolytic. Among women without preeclampsia, MgSO4 use was not higher in women hospitalised before delivery for preterm labour. Conclusions: Severe pre-eclampsia, eclampsia or HELLP are not treated with MgSO4 as frequently as evidence-based medicine recommends. MgSO4 is seldom used for fetal neuroprotection, and is no longer used for tocolysis. To continuously lower morbidity, greater attention to use of MgSO4 is needed.",

keywords = "PREVENTIVE MEDICINE",

author = "Wolf, {H. T.} and T. Weber and A. Piedvache and S. Schmidt and M. Norman and J. Zeitlin and {The EPICE Research Group} and E. Martens and G. Martens and {Van Reempts}, P. and K. Boerch and A. Hasselager and L. Huusom and O. Pryds and T. Weber and L. Toome and H. Varendi and Ancel, {P. Y.} and B. Blondel and A. Burguet and Jarreau, {P. H.} and P. Truffert and Maier, {R. F.} and B. Misselwitz and S. Schmidt and L. Gortner and D. Baronciani and G. Gargano and R. Agostino and D. DiLallo and F. Franco and V. Carnielli and M. Cuttini and C. Koopman-Esseboom and {Van Heijst}, A. and J. Nijman and J. Gadzinowski and J. Mazela and Gra{\c c}a, {L. M.} and MacHado, {M. C.} and C. Rodrigues and T. Rodrigues and H. Barros and Bonamy, {A. K.} and M. Norman and E. Wilson and E. Boyle and Draper, {E. S.} and Manktelow, {B. N.} and Fenton, {A. C.}",

year = "2017",

doi = "10.1136/bmjopen-2016-013952",

language = "English",

volume = "7",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Use of magnesium sulfate before 32 weeks of gestation

T2 - A European population-based cohort study

AU - Wolf, H. T.

AU - Weber, T.

AU - Piedvache, A.

AU - Schmidt, S.

AU - Norman, M.

AU - Zeitlin, J.

AU - The EPICE Research Group

AU - Martens, E.

AU - Martens, G.

AU - Van Reempts, P.

AU - Boerch, K.

AU - Hasselager, A.

AU - Huusom, L.

AU - Pryds, O.

AU - Weber, T.

AU - Toome, L.

AU - Varendi, H.

AU - Ancel, P. Y.

AU - Blondel, B.

AU - Burguet, A.

AU - Jarreau, P. H.

AU - Truffert, P.

AU - Maier, R. F.

AU - Misselwitz, B.

AU - Schmidt, S.

AU - Gortner, L.

AU - Baronciani, D.

AU - Gargano, G.

AU - Agostino, R.

AU - DiLallo, D.

AU - Franco, F.

AU - Carnielli, V.

AU - Cuttini, M.

AU - Koopman-Esseboom, C.

AU - Van Heijst, A.

AU - Nijman, J.

AU - Gadzinowski, J.

AU - Mazela, J.

AU - Graça, L. M.

AU - MacHado, M. C.

AU - Rodrigues, C.

AU - Rodrigues, T.

AU - Barros, H.

AU - Bonamy, A. K.

AU - Norman, M.

AU - Wilson, E.

AU - Boyle, E.

AU - Draper, E. S.

AU - Manktelow, B. N.

AU - Fenton, A. C.

PY - 2017

Y1 - 2017

N2 - Objectives: The use of magnesium sulfate (MgSO4) in European obstetric units is unknown. We aimed to describe reported policies and actual use of MgSO4 in women delivering before 32 weeks of gestation by indication. Methods: We used data from the European Perinatal Intensive Care in Europe (EPICE) population-based cohort study of births before 32 weeks of gestation in 19 regions in 11 European countries. Data were collected from April 2011 to September 2012 from medical records and questionnaires. The study population comprised 720 women with severe preeclampsia, eclampsia or HELLP and 3658 without preeclampsia delivering from 24 to 31 weeks of gestation in 119 maternity units with 20 or more very preterm deliveries per year. Results: Among women with severe pre-eclampsia, eclampsia or HELLP, 255 (35.4%) received MgSO4 before delivery. 41% of units reported use of MgSO4 whenever possible for pre-eclampsia and administered MgSO4 more often than units reporting use sometimes. In women without pre-eclampsia, 95 (2.6%) received MgSO4. 9 units (7.6%) reported using MgSO4 for fetal neuroprotection whenever possible. In these units, the median rate of MgSO4 use for deliveries without severe pre-eclampsia, eclampsia and HELLP was 14.3%. Only 1 unit reported using MgSO4 as a first-line tocolytic. Among women without preeclampsia, MgSO4 use was not higher in women hospitalised before delivery for preterm labour. Conclusions: Severe pre-eclampsia, eclampsia or HELLP are not treated with MgSO4 as frequently as evidence-based medicine recommends. MgSO4 is seldom used for fetal neuroprotection, and is no longer used for tocolysis. To continuously lower morbidity, greater attention to use of MgSO4 is needed.

AB - Objectives: The use of magnesium sulfate (MgSO4) in European obstetric units is unknown. We aimed to describe reported policies and actual use of MgSO4 in women delivering before 32 weeks of gestation by indication. Methods: We used data from the European Perinatal Intensive Care in Europe (EPICE) population-based cohort study of births before 32 weeks of gestation in 19 regions in 11 European countries. Data were collected from April 2011 to September 2012 from medical records and questionnaires. The study population comprised 720 women with severe preeclampsia, eclampsia or HELLP and 3658 without preeclampsia delivering from 24 to 31 weeks of gestation in 119 maternity units with 20 or more very preterm deliveries per year. Results: Among women with severe pre-eclampsia, eclampsia or HELLP, 255 (35.4%) received MgSO4 before delivery. 41% of units reported use of MgSO4 whenever possible for pre-eclampsia and administered MgSO4 more often than units reporting use sometimes. In women without pre-eclampsia, 95 (2.6%) received MgSO4. 9 units (7.6%) reported using MgSO4 for fetal neuroprotection whenever possible. In these units, the median rate of MgSO4 use for deliveries without severe pre-eclampsia, eclampsia and HELLP was 14.3%. Only 1 unit reported using MgSO4 as a first-line tocolytic. Among women without preeclampsia, MgSO4 use was not higher in women hospitalised before delivery for preterm labour. Conclusions: Severe pre-eclampsia, eclampsia or HELLP are not treated with MgSO4 as frequently as evidence-based medicine recommends. MgSO4 is seldom used for fetal neuroprotection, and is no longer used for tocolysis. To continuously lower morbidity, greater attention to use of MgSO4 is needed.

KW - PREVENTIVE MEDICINE

U2 - 10.1136/bmjopen-2016-013952

DO - 10.1136/bmjopen-2016-013952

M3 - Journal article

C2 - 28132012

AN - SCOPUS:85010931695

SN - 2044-6055

VL - 7

JO - BMJ Open

JF - BMJ Open

M1 - e013952

ER -

Use of magnesium sulfate before 32 weeks of gestation: A European population-based cohort study

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