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BMJ Report: Magnesium could save hundreds of women's lives worldwide

  [ 29 votes ]   [ Discuss This Article ] • June 7, 2002

By Lynn Eaton, London

Magnesium sulphate injections have been shown to halve the risk of eclampsia in pregnant women and can save their lives, concludes a major clinical trial published in this week's Lancet (2002;359:1877-90).

Over 10000 women from 33 countries, many of them in the developing world, took part in the three year, £2.5m ($3.7m; 3.9m) research study, funded by the UK Medical Research Council. All the women had pre-eclampsia. Half were randomly assigned to be given magnesium sulphate, an anticonvulsant, and the other half were given a placebo.

The women given magnesium sulphate had a 58% lower risk of developing eclampsia than women given a placebo. Although a quarter of the women given magnesium sulphate reported minor side effects, such as flushing and prickly skin, there was no evidence of harmful effects to the mother or baby, say the researchers. Moreover, although the treatment did not affect whether or not the baby died, it did reduce the risk of the mother dying.

The study, known as the Magpie (Magnesium sulphate for prevention of eclampsia) trial, is the first major controlled trial to come up with reliable empirical evidence supporting the benefits of magnesium sulphate. The drug has been used in the United States for over a century. A systematic review published in 1998 (Lancet 1998:325;1861), the collaborative eclampsia trial, involving 1687 women in nine developing countries, concluded that magnesium sulphate was the most promising choice for pre-eclampsia. It had a dramatic effect on practice in the United Kingdom.

Previously, doctors worldwide had relied on diazepam, phenytoin, lytic cocktail, and a number of other anticonvulsant treatments to reduce the risk of seizure in women who already had pre-eclampsia. A quarter of UK obstetricians never use prophylactic anticonvulsants, and those who do restrict them to women with the most severe pre-eclampsia.

Dr Lelia Duley, senior clinical fellow with the Medical Research Council and an obstetric epidemiologist in the Institute of Health Sciences, Oxford University, said the treatment could save countless lives if it were introduced routinely for pregnant women with pre-eclampsia. "Importantly," she said, "it is a very inexpensive treatment, making it especially suitable for use in low income countries."

More than 10,000 pregnant women took part in the trial.

Source: BMJ 2002;324:1351 ( 8 June ).

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