Early magnesium discontinuation postpartum and eclampsia risk: a
systematic review and meta-analysis
Abstract
Background: The optimal duration of magnesium administration postpartum
for prevention of eclampsia has not yet been established. Objective: To
investigate the effect of early discontinuation of postpartum magnesium
on the rates of postpartum eclampsia when compared to continuation for
24-hour postpartum. Search Strategy: Searches were performed using
keywords related to “preeclampsia” and “magnesium sulfate” from
inception of database until March 2019. Selection Criteria: Randomized
controlled trials of women with preeclampsia receiving magnesium prior
to delivery randomized to early discontinuation of magnesium postpartum.
The control group was 24-hours of magnesium postpartum. Data Collection
and Analysis: The primary outcome was the rate of postpartum eclampsia.
Main Results: Eight RCTs with 2,183 women were included with five
different magnesium administration time-frames. Eclampsia rates were not
different between the two groups (5/1,088 (0.5%) after early
discontinuation, versus 2/1,095 (0.2%) in the 24-hour group; RR 2.25,
95% CI 0.5-9.9, I2=0%, 8 studies, 2,183 participants). A number needed
to treat was calculated; 370 women would need to receive 24-hours of
magnesium postpartum to prevent one episode of postpartum eclampsia. The
early discontinuation group had a significant decrease in time to
ambulation and breastfeeding. Conclusions: Compared to continuation of
magnesium for 24 hours postpartum, early magnesium discontinuation
postpartum does not significantly increase the rate of postpartum
eclampsia. The largest proportion of women did not receive magnesium
postpartum after receiving at least 8 grams intrapartum, thus it is
reasonable to consider discontinuation of magnesium postpartum if a
woman has received similar adequate dose prior to delivery.