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Table 5 Adverse effect estimates from comparative studies with concurrent controls

From: Maternal adverse effects of different antenatal magnesium sulphate regimens for improving maternal and infant outcomes: a systematic review

Study

Participants and comparison

Adverse effect

Estimates

Effect estimate (95% CI)

Magnesium sulphate versus no magnesium sulphate

Chowdhury 2000 [46]

630 women (E). Low dose IV (4 g IV LD over 2–3 mins; 5 g/8 h IV MD) (n = 150) v Pritchard’s IM regimen (4 g IV and 10 g IM LD; 5 g/4 h IM MD) (n = 480)

Major adverse effects; respiratory depression

0.0% v 0.0%

NA

  

Absent knee jerks and oliguria; stopped dosing due to adverse effects

0.0% v 3.2%

RR 0.10 (0.01, 1.71)

  

Pain at injection site

0.0% v 55.0%

RR 0.01 (0.00, 0.10)

Mahajan 2007 [47]

95 women (E). 1. (2 g IV and 4 g IM LD; 4 g IM/4 h) (n = 37) v 2. (2 g IV and 8 g IM LD; 4 g IM/4 h) (n = 58)

Respiratory depression

0.0% v 0.0%

NA

  

Absent knee jerks and MD omitted

56.8% v 31.0%

RR 1.83 (1.14, 2.94)

Young 1977 [48]

144 women (PE or E). 1. (10 g IM LD; 2 g slow IV 'push’ with repeated doses every 1–2 h) (n = 97) v 2. (10 g IM LD; continuous IV 1 g/h) (n = 47)

Death

0.0% v 0.0%

NA

  

Heat and flushing

92.8% v 0.0%

RR 88.65 (5.62, 1397.80)

  

Respiratory effects (slowing respirations to complete apnoea)

79.4% v 0.0%

RR 75.92 (4.81, 1198.55)

Shoaib 2009 [49]

100 women (severe PE). LD only (4 g IV and 10 g IM LD) (n = 50) v Pritchard’s IM regimen (4 g IV and 10 g IM LD; 5 g/4 h IM) (n = 50)

Death; respiratory failure or distress; cardiac arrest

0.0% v 0.0%

NA

  

Nausea and vomiting

10.0% v 34.0%

RR 0.29 (0.12, 0.74)

  

Warmth and flushing

70.0% v 80.0%

RR 0.88 (0.70, 1.10)

  

Dizziness

20.0% v 56.0%

RR 0.36 (0.19, 0.65)

  

Irritation at the injection site

0.0% v 20.0%

RR 0.05 (0.00, 0.79)

  

Caesarean

12.0% v 30.0%

RR 0.40 (0.17, 0.95)

Palmer 2009 [50]

76 women (PE). New protocol (20% solution, separate LD and MD bags) (n = 29) v Old protocol (2-8% solution, same LD and MD bag) (n = 47)

Phlebitis; signs or symptoms of toxicity

0.0% v 0.0%

NA

  

Calcium gluconate (for hypocalcaemia)

3.5% v 4.3%

RR 0.81 (0.08, 8.54)

  

Errors (failure to reset pump after LD)

0.0% v 4.3%

RR 0.32 (0.02, 6.44)

  

Errors (change in drug order)

3.5% v 2.1%

RR 1.62 (0.11, 24.92)

Nassar 2006 [51]

155 women (PTL). 1. Treatment for > 48 hours (n = 78) v 2. Treatment for < 48 hours (n = 77)

≥ 1 adverse effect

30.8% v 15.6%

OR 2.41 (1.10, 5.26)

  

Discontinuation due to adverse effects

6.4% v 0.0%

OR 11.60 (0.63, 213.47)

  

Chest tightness

19.2% v 11.8%

OR 1.80 (0.74, 4.40)

  

Visual disturbances

6.4% v 1.3%

OR 5.21 (0.59, 45.63)

  

Vulvar oedema

1.3% v 0.0%

OR 3.00 (0.12, 74.79)

  

Pulmonary oedema

6.4% v 2.6%

OR 2.57 (0.48, 13.66)

  

Ileus

3.8% v 1.3%

OR 3.04 (0.31, 29.89)

  

Osteopenia

2.6% v 0.0%

OR 5.07 (0.24, 107.25)

  

Hypocalcaemia (< 8.5 mg/dl)

24.6% v 15.6%

OR 1.77 (0.74, 4.21)

  1. The bold effect estimates indicate statistical significance.
  2. Abbreviations: CI confidence interval, E eclampsia, g grams, h hours, IM intramuscular, IV intravenous, LD loading dose, MgSO4 magnesium sulphate, MD maintenance dose, mins minutes, OR odds ratio, PE pre-eclampsia, PTL preterm labour, RR risk ratio.