Antenatal magnesium sulphateBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c6004 (Published 22 November 2010) Cite this as: BMJ 2010;341:c6004
- D M Peebles, professor of obstetrics1,
- N Marlow, professor of neonatal medicine1,
- P Brocklehurst, professor of perinatal epidemiology2
- 1Institute for Women’s Health, University College London, London WC1E 6HX, UK
- 2National Perinatal Epidemiology Unit, University of Oxford, Oxford OX3 7LF, UK
Most clinical research into preterm delivery is based on the assumption that neonatal and therefore childhood outcomes are better the longer gestation proceeds and that delaying delivery is beneficial. However, strategies that prolong pregnancy have not been shown to improve the outcome for the child⇓.
For example, neither of two recent randomised controlled trials showing that antenatal administration of progesterone reduces the number of women delivering preterm found that prolongation of pregnancy improved neonatal outcome, let alone longer term outcomes of surviving children.1 2 The need for follow-up data is highlighted by the ORACLE Children Study. Despite no discernable effect in the immediate neonatal period, cerebral palsy was more common in the offspring of women who received erythromycin, co-amoxiclav, or both antibiotics during spontaneous preterm labour compared with those who received placebo at the seven year follow-up (erythromycin v no erythromycin: odds ratio 1.93, 95% confidence interval 1.21 to 3.09; co-amoxiclav v no co-amoxiclav: 1.69, 1.07 to 1.67).3 These results imply that such intervention may have detrimental delayed effects.
Antenatal interventions to treat the fetus rather than prolong gestation can improve child outcomes. A recent systematic review that included trials over many …