Comparison of the efficacy and safety of different magnesium sulfate regimens for the prevention and treatment of hypertensive disorders during pregnancy, childbirth, and the postpartum period

Abstract

The use of magnesium sulfate to prevent seizures during pregnancy, childbirth, and the postpartum period in women with preeclampsia is the gold standard and is included in the clinical guidelines approved by the Ministry of Health of the Russian Federation. Although numerous studies have evaluated different regimens and administration protocols for magnesium sulfate, definitive evidence supporting an optimal regimen is still lacking. Therefore, this systematic review aimed to identify and analyze publications providing a comparative assessment of the efficacy and safety of alternative magnesium sulfate regimens, with particular attention to maternal and perinatal outcomes. The search was conducted in the PubMed, ClinicalTrials.gov, Cochrane, and MEDLINE databases for the period 2015–2023. Out of 537 identified sources, 10 studies (2,399 patients in total) were selected for analysis, including 9 randomized and 1 non-randomized study. Comparisons were made between standard (high-dose) and alternative (low-dose) regimens, between loading dose-only regimens and full regimens (loading + maintenance dose), as well as between standard-duration regimens (24–48 hours) and shortened regimens (6–12 hours). Low-dose regimens were comparable to high-dose regimens in terms of efficacy for seizure prevention (OR 0.56; p = 0.08) and their impact on maternal and perinatal morbidity and mortality rates but were associated with fewer side effects (OR 0.35; p < 0.0001). Similarly, loading dose regimens and shortened-duration regimens demonstrated comparable efficacy with fewer complications. Thus, shortened-duration and low-dose regimens appear to be safe and effective alternatives to standard regimens. However, limited data, variability in outcomes, and insufficient stratification restrict the certainty of this conclusion. Large multicenter randomized trials are needed to validate these results. Key words: hypertensive disorders of pregnancy, pre-eclampsia, eclampsia, magnesium sulfate, administration regimens, prevention, systematic review