Home Medicine Effect of magnesium sulfate and nifedipine on the risk of developing pulmonary edema in preterm births
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Effect of magnesium sulfate and nifedipine on the risk of developing pulmonary edema in preterm births

  • ChengWei Xiao , Mihnea Gangal and Haim A. Abenhaim EMAIL logo
Published/Copyright: February 25, 2014
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 42 Issue 5

Abstract

Objective: To evaluate the risk of developing pulmonary edema in women exposed to nifedipine, magnesium sulfate (MgSO4), or both in a preterm setting.

Study design: We carried out a retrospective case-control study at a large tertiary care center from 2007 to 2012. Cases of pulmonary edema were age, and gestational age matched to controls at a ratio of 1 case to 4 controls. Logistic regression analysis was used to estimate the effect of nifedipine and/or MgSO4 on the development of pulmonary edema while controlling for predetermined confounding variables. Stepwise logistic regression analysis was used to evaluate additional risk factors of pulmonary edema.

Results: A total of 150 charts were reviewed (28 cases and 122 controls). Nifedipine did not increase the odds of developing pulmonary edema [adjusted odds ratio (OR)=1.22 (confidence interval (CI) 0.50, 3.01), P=0.67], whereas exposure to MgSO4, or both MgSO4 and nifedipine, significantly increased the risk of developing pulmonary edema [adjusted OR=3.91 (CI 1.44, 10.65), P=0.008 and adjusted OR=4.75 (CI 1.15, 19.71), P=0.032, respectively]. In the stratified analysis, this association persisted even in nonpreeclamptic women [nifedipine: adjusted OR=0.91 (CI 0.33, 2.52), P=0.852; MgSO4: adjusted OR=3.51 (CI 1.26, 9.76), P=0.016; both: adjusted OR=3.39 (0.76, 15.07), P=0.108]. Other independent risk factors for pulmonary edema were multi-fetal pregnancy, azithromycin, and erythromycin administration.

Conclusion: MgSO4 treatment is strongly associated with the development of pulmonary edema when used either as a tocolytic agent or for seizure prophylaxis. In light of the availability of safer alternatives, MgSO4 should be used for tocolysis only in cases whereby the benefits clearly outweigh the risks.

Keywords: Preterm birth; pulmonary edema; tocolytics
Corresponding author: Haim A. Abenhaim, MD, MPH, Department of Obstetrics and Gynecology, Jewish General Hospital, 5790 Cote-des-Neiges, H412, Montreal, QC, H3T 1E2 Canada, Tel.: +(514) 340-8222x5488, Fax: +(514) 340-7941, E-mail:

Funding source: Funding: Funding was obtained from our institution

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The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2013-12-12
Accepted: 2014-1-31
Published Online: 2014-2-25
Published in Print: 2014-9-1

©2014 by De Gruyter

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. The CROWN Initiative: journal editors invite researchers to develop core outcomes in women’s health
  4. Academy’s Corner
  5. Invasive or non-invasive prenatal genetic diagnosis?
  6. Original articles - Obstetrics
  7. Effect of depth on shear-wave elastography estimated in the internal and external cervical os during pregnancy
  8. Analysis of measurement process of placental volume in early pregnancy: an interobserver reliability study
  9. Acute pancreatitis in pregnancy: a comparison of associated conditions, treatments and complications
  10. Cesarean section and placental disorders in subsequent pregnancies – a meta-analysis
  11. Effect of magnesium sulfate and nifedipine on the risk of developing pulmonary edema in preterm births
  12. Prediction of preeclampsia by placental protein 13 and background risk factors and its prevention by aspirin
  13. Maternal and neonatal outcome of labour induction at term comparing two regimens of misoprostol
  14. Comparison of placental alpha microglobulin-1 in vaginal fluid with intra-amniotic injection of indigo carmine for the diagnosis of rupture of membranes
  15. Clinical differences between early- and late-onset severe preeclampsia and analysis of predictors for perinatal outcome
  16. Maternal serum placental growth factor and fetal SGA in pregnancy complicated by type 1 diabetes mellitus
  17. Original article – Fetus
  18. Imaging of fetal thymus in pregnant women with rheumatic diseases
  19. Original articles – Newborn
  20. Milk demystified by chemistry
  21. Absence of antibodies against Bordetella pertussis in pregnant women and newborns in the state of Nuevo Leon
  22. Mortality among sons of female dental personnel – a national cohort study
  23. IAPM Statements 2005–2012
  24. DECLARATIONS of the “International Academy of Perinatal Medicine” (IAPM)
  25. Congress Calendar
  26. Congress Calendar
https://doi.org/10.1515/jpm-2013-0340
Keywords for this article
Preterm birth; pulmonary edema; tocolytics

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. The CROWN Initiative: journal editors invite researchers to develop core outcomes in women’s health
  4. Academy’s Corner
  5. Invasive or non-invasive prenatal genetic diagnosis?
  6. Original articles - Obstetrics
  7. Effect of depth on shear-wave elastography estimated in the internal and external cervical os during pregnancy
  8. Analysis of measurement process of placental volume in early pregnancy: an interobserver reliability study
  9. Acute pancreatitis in pregnancy: a comparison of associated conditions, treatments and complications
  10. Cesarean section and placental disorders in subsequent pregnancies – a meta-analysis
  11. Effect of magnesium sulfate and nifedipine on the risk of developing pulmonary edema in preterm births
  12. Prediction of preeclampsia by placental protein 13 and background risk factors and its prevention by aspirin
  13. Maternal and neonatal outcome of labour induction at term comparing two regimens of misoprostol
  14. Comparison of placental alpha microglobulin-1 in vaginal fluid with intra-amniotic injection of indigo carmine for the diagnosis of rupture of membranes
  15. Clinical differences between early- and late-onset severe preeclampsia and analysis of predictors for perinatal outcome
  16. Maternal serum placental growth factor and fetal SGA in pregnancy complicated by type 1 diabetes mellitus
  17. Original article – Fetus
  18. Imaging of fetal thymus in pregnant women with rheumatic diseases
  19. Original articles – Newborn
  20. Milk demystified by chemistry
  21. Absence of antibodies against Bordetella pertussis in pregnant women and newborns in the state of Nuevo Leon
  22. Mortality among sons of female dental personnel – a national cohort study
  23. IAPM Statements 2005–2012
  24. DECLARATIONS of the “International Academy of Perinatal Medicine” (IAPM)
  25. Congress Calendar
  26. Congress Calendar
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