Antenatal Magnesium Sulfate and Adverse Gastrointestinal Outcomes in Preterm Infants - A Systematic Review and Meta-Analysis

Background: Magnesium sulphate is widely used in antenatal mothers for various indications such as neuroprotection, tocolysis and preeclampsia. Some studies suggest that there is alteration in intestinal motility and blood flow in preterm neonates as a result of exposure to Magnesium sulphate. Objective: To evaluate the effect of antenatal magnesium Sulphate (MgSO 4 ) on mortality and morbidity outcomes related to the gastrointestinal system (GI) in preterm infants. Search strategy PubMed, CINAHL, Embase, and CENTRAL were searched through up to November 2022. Data collection and Analysis Two authors independently conducted data extraction. A random-effects model meta-analysis was performed. All included studies were assessed for methodological quality using appropriate quality assessment tool. The GRADE approach was used to assess the overall certainty of evidence. Main Results A total of thirty-eight observational and six RCTs involving 51,466 preterm infants were included. There were no increased odds of stage ≥2 NEC, (n= 50,727, OR:1.0; 95% CI: 0.89-1.12, I 2 - 7%), SIP ( n= 34,186, OR: 1.22, 95% CI: 0.94-1.58, I 2 -30% ), feed intolerance (n= 414, OR: 1.06, 95% CI: 0.64-1.76, I 2 -12%) in infants exposed to antenatal MgSO 4 . On the contrary, the incidence of surgical NEC was significantly lower in MgSO 4 exposure infants (n= 29,506 OR:0.74; 95% CI: 0.62-0.90, ARR: 0.47%). Studies assessing the effect on GI-related mortality were sparse to make any conceivable conclusion. GRADE certainty of findings were ‘very low’. Conclusion: Antenatal MgSO 4 did not increase the incidence of gastrointestinal-related morbidities or mortality in preterm infants.