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Magnesium sulphate for fetal neuroprotection at imminent risk for preterm delivery: a systematic review with meta-analysis and trial sequential analysis

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@article{1a15b68e2bb54a21bc35923e10386474,
title = "Magnesium sulphate for fetal neuroprotection at imminent risk for preterm delivery: a systematic review with meta-analysis and trial sequential analysis",
abstract = "Background: Ordinary meta-analyses indicate that magnesium sulphate (MgSO 4) treatment in women at imminent risk for preterm delivery decreases the offspring's risk of cerebral palsy (CP). However, repetitive testing of cumulative data calls for statistical caution, e.g. by trial sequential analysis (TSA), for which there are previously insufficient samples to draw a firm conclusion. Recently, a randomised controlled trial (RCT) provided additional data that potentially increased the sample size such that a new TSA might detect a statistically significant effect. Objectives: To assess the possible fetal neuroprotective effect of MgSO 4 for women at imminent risk for preterm delivery in an updated systematic review with meta-analysis and TSA. Search strategy: We searched MEDLINE, Embase, Cochrane and ClinicalTrials.gov on 8 October 2019. The search strategy clustered terms describing the MgSO 4 intervention and preterm delivery. Selection criteria: RCTs. Data collection and analysis: Two reviewers extracted the data. Summary relative risks (RRs) and 95{\%} confidence intervals (CIs) were calculated using fixed-effects models. A TSA was applied to the primary outcome, CP. The quality of the evidence was assessed using GRADE. The protocol was registered in PROSPERO (registration: CRD42019151441). Main results: We identified six eligible trials (5917 women). MgSO 4 intervention in women at imminent risk for preterm birth decreased the offspring's CP risk (meta-analysis RR 0.68, 95{\%} CI 0.54–0.85; TSA RR 0.69, 95{\%} CI 0.48–0.97). Conclusions: This systematic review with meta-analysis and TSA shows conclusively that MgSO 4, when given to women at imminent risk for preterm delivery, decreases the offspring's CP risk. Tweetable abstract: Antenatal magnesium sulphate decreases the risk of cerebral palsy in children born preterm.",
keywords = "Cerebral palsy, magnesium sulphate, meta-analysis, MgSO, neuroprotection, preterm delivery, systematic review, trial sequential analysis, Neuroprotective Agents/therapeutic use, Risk Assessment, Humans, Premature Birth/drug therapy, Randomized Controlled Trials as Topic/methods, Cerebral Palsy/prevention & control, Magnesium Sulfate/therapeutic use, Pregnancy, Infant, Premature, Female, Prenatal Care/methods, Infant, Newborn",
author = "Wolf, {Hanne Trap} and Huusom, {Lene Drasbek} and Henriksen, {Tine Brink} and Hegaard, {Hanne Kristine} and Jesper Brok and Anja Pinborg",
note = "{\circledC} 2020 Royal College of Obstetricians and Gynaecologists.",
year = "2020",
month = "9",
doi = "10.1111/1471-0528.16238",
language = "English",
volume = "127",
pages = "1180--1188",
journal = "BJOG: An International Journal of Obstetrics and Gynaecology",
issn = "1470-0328",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "10",

}

RIS

TY - JOUR

T1 - Magnesium sulphate for fetal neuroprotection at imminent risk for preterm delivery

T2 - a systematic review with meta-analysis and trial sequential analysis

AU - Wolf, Hanne Trap

AU - Huusom, Lene Drasbek

AU - Henriksen, Tine Brink

AU - Hegaard, Hanne Kristine

AU - Brok, Jesper

AU - Pinborg, Anja

N1 - © 2020 Royal College of Obstetricians and Gynaecologists.

PY - 2020/9

Y1 - 2020/9

N2 - Background: Ordinary meta-analyses indicate that magnesium sulphate (MgSO 4) treatment in women at imminent risk for preterm delivery decreases the offspring's risk of cerebral palsy (CP). However, repetitive testing of cumulative data calls for statistical caution, e.g. by trial sequential analysis (TSA), for which there are previously insufficient samples to draw a firm conclusion. Recently, a randomised controlled trial (RCT) provided additional data that potentially increased the sample size such that a new TSA might detect a statistically significant effect. Objectives: To assess the possible fetal neuroprotective effect of MgSO 4 for women at imminent risk for preterm delivery in an updated systematic review with meta-analysis and TSA. Search strategy: We searched MEDLINE, Embase, Cochrane and ClinicalTrials.gov on 8 October 2019. The search strategy clustered terms describing the MgSO 4 intervention and preterm delivery. Selection criteria: RCTs. Data collection and analysis: Two reviewers extracted the data. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using fixed-effects models. A TSA was applied to the primary outcome, CP. The quality of the evidence was assessed using GRADE. The protocol was registered in PROSPERO (registration: CRD42019151441). Main results: We identified six eligible trials (5917 women). MgSO 4 intervention in women at imminent risk for preterm birth decreased the offspring's CP risk (meta-analysis RR 0.68, 95% CI 0.54–0.85; TSA RR 0.69, 95% CI 0.48–0.97). Conclusions: This systematic review with meta-analysis and TSA shows conclusively that MgSO 4, when given to women at imminent risk for preterm delivery, decreases the offspring's CP risk. Tweetable abstract: Antenatal magnesium sulphate decreases the risk of cerebral palsy in children born preterm.

AB - Background: Ordinary meta-analyses indicate that magnesium sulphate (MgSO 4) treatment in women at imminent risk for preterm delivery decreases the offspring's risk of cerebral palsy (CP). However, repetitive testing of cumulative data calls for statistical caution, e.g. by trial sequential analysis (TSA), for which there are previously insufficient samples to draw a firm conclusion. Recently, a randomised controlled trial (RCT) provided additional data that potentially increased the sample size such that a new TSA might detect a statistically significant effect. Objectives: To assess the possible fetal neuroprotective effect of MgSO 4 for women at imminent risk for preterm delivery in an updated systematic review with meta-analysis and TSA. Search strategy: We searched MEDLINE, Embase, Cochrane and ClinicalTrials.gov on 8 October 2019. The search strategy clustered terms describing the MgSO 4 intervention and preterm delivery. Selection criteria: RCTs. Data collection and analysis: Two reviewers extracted the data. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using fixed-effects models. A TSA was applied to the primary outcome, CP. The quality of the evidence was assessed using GRADE. The protocol was registered in PROSPERO (registration: CRD42019151441). Main results: We identified six eligible trials (5917 women). MgSO 4 intervention in women at imminent risk for preterm birth decreased the offspring's CP risk (meta-analysis RR 0.68, 95% CI 0.54–0.85; TSA RR 0.69, 95% CI 0.48–0.97). Conclusions: This systematic review with meta-analysis and TSA shows conclusively that MgSO 4, when given to women at imminent risk for preterm delivery, decreases the offspring's CP risk. Tweetable abstract: Antenatal magnesium sulphate decreases the risk of cerebral palsy in children born preterm.

KW - Cerebral palsy

KW - magnesium sulphate

KW - meta-analysis

KW - MgSO

KW - neuroprotection

KW - preterm delivery

KW - systematic review

KW - trial sequential analysis

KW - Neuroprotective Agents/therapeutic use

KW - Risk Assessment

KW - Humans

KW - Premature Birth/drug therapy

KW - Randomized Controlled Trials as Topic/methods

KW - Cerebral Palsy/prevention & control

KW - Magnesium Sulfate/therapeutic use

KW - Pregnancy

KW - Infant, Premature

KW - Female

KW - Prenatal Care/methods

KW - Infant, Newborn

U2 - 10.1111/1471-0528.16238

DO - 10.1111/1471-0528.16238

M3 - Journal article

VL - 127

SP - 1180

EP - 1188

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

SN - 1470-0328

IS - 10

ER -

ID: 59656560