- 1 Clinical Question
- 2 Bottom Line
- 3 Major Points
- 4 Guidelines
- 5 Design
- 6 Population
- 7 Interventions
- 8 Outcomes
- 9 Criticisms
- 10 Funding
- 11 Further Reading
In pregnant women with preeclampsia, does magnesium sulphate decrease maternal and neonatal mortality and morbidity when compared with placebo?
Magnesium sulphate significantly decreases the risk of eclampsia in pregnant women with preeclampsia.
Pre-eclampsia is a systemic disorder affecting 2-8% of pregnancies. Prior to the Magpie Trial, anticonvulsants had been used for many years to prevent the risk of seizure, with magnesium sulphate emerging as possibly the most effective.
Several small and large randomized trials in diabetics had previously suggested a sizable benefit of tight glycemic control in reducing cardiovascular risk. The ACCORD trial was the largest study of its kind and demonstrated that not only does euglycemia (ie, HbA1c <6%) not reduce cardiovascular risk, it also is associated with a trend towards increased mortality.
- International, multi-centre, double-blind, parallel-group, randomized controlled trial
- Magnesium sulphate (n=5,071)
- Placebo (n=5,070)
- Setting: 175 secondary and tertiary hospitals in 33 countries with overall coordination in Oxford, UK
- Enrollment: February to July 1998 (pilot), July 1998 to Nov 2001 (main trial)
- Mean follow-up:
- Analysis: Intention-to-treat
- Primary outcome:
- Not yet given birth or <24 hours postpartum
- BP >=90 mmHg diastolic or >=140 mmHg systolic on at least 2 occasions
- Proteinuria 1+ (30 mg/dL) or more
- Clinical uncertainty about whether magnesium sulphate would be beneficial
- Hypersensitivity to magnesium
- Hepatic coma with risk of renal failure
- Myasthenia gravis
- Demographics: Age ## years
Comparisons are magnesium sulphate vs. placebo.
- OUTCOME NAME
- ##% vs. ##% (HR ##; 95% CI ##-##; P=##)
- UK Medical Research Council
- UK Department for International Development
- The UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)