Oral Plenary Session 2 - Fellows Plenary
Oral Plenary Sessions
Margaret R. Page, MD
Fellow
Center for Research in Women’s Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Barbara Do, N/A
RTI International
Research Triangle Park, North Carolina, United States
Namasivayam Ambalavanan, MD
University of Alabama at Birmingham Heersink School of Medicine
Birmingham, Alabama, United States
Colm P. Travers, MD, MSPH
Assistant Professor in the Division of Neonatology
Department of Pediatrics, University of Alabama at Birmingham Heersink School of Medicine
Birmingham, Alabama, United States
Waldemar A. Carlo, MD
Department of Pediatrics, University of Alabama at Birmingham
Birmingham, Alabama, United States
Samuel Gentle, MD
University of Alabama at Birmingham Heersink School of Medicine
Birmingham, Alabama, United States
Amelia Schuyler, MD
University of Alabama at Birmingham Heersink School of Medicine
Birmingham, Alabama, United States
Akila Subramaniam, MD, MPH (she/her/hers)
Professor
Center for Research in Women’s Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Ashley N. Battarbee, MD, MSCR
Associate Professor, Maternal-Fetal Medicine
Center for Research in Women’s Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
SMFM and ACOG recommend magnesium sulfate for neuroprotection before delivery at 24 0/7-31 6/7 weeks and advise consideration at 23 weeks. At 22 weeks, magnesium sulfate is not recommended although corticosteroids can be considered. We aimed to evaluate the association between in utero magnesium exposure and 2-year neurodevelopmental outcomes after periviable delivery.
Study Design:
Multicenter cohort study of prospectively collected data of children born at 22 0/7-24 6/7 weeks from 2012-2022 in NICHD Neonatal Research Network hospitals and had 2-year follow-up. Children with congenital anomalies, death at < 12 postnatal hours, and from high-order multiple gestation were excluded. The primary outcome was severe neurodevelopmental impairment (NDI) or death at 2 years (Table 1). Baseline characteristics and outcomes were compared between those exposed to magnesium versus not exposed. Multilevel logistic regression estimated the association between magnesium exposure and outcomes with tests for effect modification by delivery gestational age (GA).
Results:
Of 4,179 included children, 3,242 (78%) were exposed to magnesium and 937 (22%) were not exposed. Children exposed to magnesium were more likely to have maternal private insurance, antenatal corticosteroid and antibiotic exposure, cesarean delivery, and later delivery GA. Children exposed to magnesium had lower rates of severe NDI or death (63% vs 70%, p< 0.01) and other outcomes (Table 1). These associations were not significant after adjusting for covariates (aOR 1.00, CI 0.81-1.25), but significance could be restored with exclusion of corticosteroids (aOR 0.78, CI 0.65-0.95; Table 1). The lack of association between magnesium and NDI or death was consistent across all delivery GA (Table 2).
Conclusion:
In utero magnesium exposure before delivery at 22 0/7-24 6/7 weeks was not independently associated with better neurodevelopmental outcomes at 2 years after accounting for antenatal corticosteroid receipt. Management of pregnant patients at risk of periviable delivery should prioritize antenatal corticosteroid administration.