USE OF MAGNESIUM IN OBSTETRICS: MYTHS AND FACTS
https://doi.org/10.17749/2313-7347.2017.11.3.059-068
Abstract
Aim: to elucidate the role of magnesium deficiency in obstetric complications and to characterize the ways to prevent them by using oral administration of organic magnesium salts.
Materials and methods. We analyzed publications of the Cochrane society, recommendations of obstetrics communities, clinical studies published in official websites and other information available to the public.
Results.According to two multicenter studies conducted in Russia in 2012 and 2013 (MAGIC and MAGIC 2), magnesium deficiency was diagnosed in 81.2% and 80.9% of pregnant women, respectively. Meta-analyzes of the data published by the Cochrane society showed that an oral administration of organic magnesium salts for 3 weeks caused a significant decrease or disappearance of leg cramps in 65.5% of pregnant women (vs 5.7% with placebo). Treatment with magnesium during the period before the 25th week of pregnancy reduced the risk of complications as follows: premature births – by 27%; births of low weight babies – by 33%; mother hospitalization – by 34%; risk of spontaneous abortion – by 62%. In all the studies where pregnant women took oral magnesium medications, there was a low incidence of side effects.
Conclusion.Measures to prevent magnesium deficiency both at the stage of preparation for pregnancy and during gestation, starting from the first weeks, help avoid some complications and improves the outcomes for the fetus and the newborn.
About the Author
G. B. Dikke
Peoples' Friendship University of Russia
Russian Federation
Russian Federation
Dikke Galina Borisovna – Honored Scientist and Educator, MD, Professor, Department of Obstetrics, Gynecology and ReproductiveMedicine, Faculty of Advanced Training.
Ul. Miklukho-Maklaya, 6, Moscow, 117198
References
1. Order of Health Ministry of Russian Federation № 572n from November 1, 2012 On Approval of the Order of Medical Assistance on the Obstetrics and Gynecology profile (except for the use of assisted reproductive technologies) [Prikaz Ministerstva zdravoohraneniya RF ot 1 noyabrya 2012 g. № 572n Ob utverzhdenii Poryadka okazaniya medicinskoj pomoshchi po profilyu «Akusherstvo i ginekologiya (za isklyucheniem ispol'zovaniya vspomogatel'nyh reproduktivnyh tekhnologij)» (Zaregistrirovano v Minyuste RF 02.04.2013. № 27960)]. URL: http://www.garant.ru/ (in Russian) [Accessed: 10.08.2017].
2. Radzinskiy V.E. Obstetric aggression v. 2.0 [Akusherskaya agressiya v. 2,0.] Moskva: Izd-vo zhurnala Status Rraesens. 2017: 872 s (in Russian).
3. Azria E., Tsatsaris V., Goffinet F. et al. Magnesium sulfate in obstetrics: current data. J Gynecol Obstet Biol Reprod (Paris). 2004; 33 (6 Pt 1): 510-7.
4. Grimes D.A., Nanda K. Magnesium sulfate tocolysis: time to quit. Obstet Gynecol. 2006; 108 (4): 986-9.
5. Terrone D.A., Rinehart B.K., Kimmel E.S. et al. A prospective, randomized, controlled trial of high and low maintenance doses of magnesium sulfate for acute tocolysis. Am J Obstet Gynecol. 2000; 182 (6): 1477-82.
6. Rempis R. Prevalence of hypomagnesemia in an unselected German population of 16 000 individuals. Magnes Res. 2001; 14 (4): 283-90.
7. Serov V.N., Blinov D.V., Zimovina U.V., Jobava E.M. The results of a study of the prevalence of magnesium deficiency in pregnant women [Rezul'taty issledovaniya rasprostranennosti deficita magniya u beremennyh]. Akusherstvo i ginekologiya. 2014; 4: 33-40 (in Russian).
8. Orlova S.V. Chelate complexes in nutritional and dietetics [Helatnye kompleksy v nutriciologii i dietologii]. 3-e izd., pererab. I dop. Moskva. 2007: 72 s (in Russian).
9. Spätling L., Classen H.G., Kisters K. et al. Supplementation of Magnesium in Pregnancy. J Preg Child Health. 2017; 4: 302. DOI: 10.4172/2376-127X.1000302.
10. Makatsariya A.D., Bitsadze V.O., Khizroeva D.Kh., Jobava E.M. Prevalence of magnesium deficiency in pregnant women [Rasprostranennost' deficita magniya u beremennyh zhenshchin]. Voprosy ginekologii, akusherstva i perinatologii. 2012; 11 (5): 25-3 (in Russian).
11. Gromova O.A., Serov V.N., Torshin I.Yu. Magnesium in obstetrics and gynecology: history of application and modern views [Magnij v akusherstve i ginekologii: istoriya primeneniya i sovremennye vzglyady]. Trudnyj pacient. 2008; 8 (6): 20-8 (in Russian).
12. Nutrition During Pregnancy. АCOG. FAQ001, April 2015. 3 р. URL: https://www.acog.org/Patients/FAQs/Nutrition-During-Pregnancy [Accessed: 10.08.2017].
13. Serra M.J., Baird J.D., Dale T. et al. Effects of magnesium ions on the stabilization of RNA oligomers of defined structures. RNA. 2002; 8: 307-23.
14. Hartwig A. Role of magnesium in genomic stability. Mutat Res. 2001; 475 (1-2): 113-21.
15. Gromova O.A. Magnesium and pyridoxine: bases of knowledge [Magnij i piridoksin: osnovy znanij]. Moskva: ProtoTip. 2006: 234 s (in Russian).
16. Gromova O.A. Vitamins and trace elements in preconception, during pregnancy and in nursing mothers [Vitaminy i mikroelementy v prekoncepcii, pri beremennosti i u kormyashchih materej. Klinicheskaya farmakologiya. Obuchayushchie programmy YuNESKO: posobie dlya vrachej (Pod red. V.M. Sidel'nikovoj)]. Moskva. 2006: 124 s (in Russian).
17. Fofanova I.Yu. The magnesium deficiency and its connection with obstetric pathology [Deficit magniya i ego svyaz' s akusherskoj patologiej]. Medicinskij sovet. 2013; 5: 34-41 (in Russian).
18. Altura B.M., Shah N.C., Jiang X.C. et al. Short-term magnesium deficiency results in decreased levels of serum sphingomyelin, lipid peroxidation, and apoptosis in cardiovascular tissues. Am J Physiol Heart Circ Physiol. 2009; 297 (1): 86-92.
19. Schlegel R.N., Cuffe J.S., Moritz K.M., Paravicini T.M. Maternal hypomagnesemia causes placental abnormalities and fetal and postnatal mortality. Placenta. 2015; 36 (7): 750-8.
20. Vorontsov I.M. Pediatric aspects of nutritional support for women in preparation for pregnancy and its medical monitoring [Pediatricheskie aspekty pishchevogo obespecheniya zhenshchin pri podgotovke k beremennosti i pri eyo vrachebnom monitoringe]. Pediatriya. 1999; 5: 87-92 (in Russian).
21. Spasov A.A. Magnesium in medical practice [Magnij v medicinskoj praktike]. Volgograd: Otrok. 2000: 272 s (in Russian).
22. Gromova O.A,. Andreev A.V., Skalny A.V., Bykov A.T. Effect of Magne B6 on cerebrovascular reactivity in children with attention deficit disorder depending on the magnesium content in the body [Vliyanie preparata Magne B6 na cerebrovaskulyarnuyu reaktivnost' u detej s sindromom deficit vnimaniya v zavisimosti ot soderzhaniya magniya v organizme]. Klinicheskaya farmakologiya i terapiya. 2000; 5: 31-4 (in Russian).
23. Bruno V. Antidegenerativ effects of Mg2+ – valproate in cultured cerebellar neurons. Funct Neirol. 1995; 10 (3): 121-30.
24. Lidegaard Ø., Løkkegaard E., Jensen A. et al. Thrombotic stroke and myocardial infarction with hormonal contraception. N Engl J Med. 2012; 366: 2257-66.
25. Lidegaard Ø., Nielsen L.H., Skovlund C.W. et al. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and estrogen doses: Danish cohort study 2001-9. BMJ. 2011; 343: d6423.
26. Hron G., Lombardi R., Eichinger S. et al. Low vitamin B6 levels and the risk of recurrent venous thromboembolism. Haematologica. 2007; 92: 1250-3.
27. Chushkov Yu.V. Modern possibilities of correction of magnesium deficiency in obstetrics [Sovremennye vozmozhnosti korrekcii deficita magniya v akusherstve]. RMZh. 2012; 17: 867-73 (inRussian).
28. Nikolaeva L.B., Makatsaria A.D., Shestopalova E.A., Prosvetova A.A. The role of magnesium preparations in improving the outcomes of the first pregnancy [Rol' preparatov magniya v uluchshenii iskhodov pervoj beremennosti]. Akusherstvo i ginekologiya. 2013; 11: 79-82 (in Russian).
29. Mishra O.P., Fritz K.I., DelivoriaPapadopoulos M. NMDA receptor and neonatal hypoxic brain injury. Ment Retard Dev Disabil Res Rev. 2001; 7 (4): 249-53.
30. Qin J., Chai G., Brewer J.M. et al. Structures of asymmetric complexes of human neuron specific enolase with resolved substrate and product and an analogous complex with two inhibitors indicate subunits interaction and inhibitors cooperativity. J Inorg Biochem. 2012; 111: 187-94.
31. Torshin I.Yu., O. Gromova. Mechanisms of antistress and antidepressant action of magnesium and pyridoxine [Mekhanizmy antistressovogo i antidepressivnogo dejstviya magniya i piridoksina]. Zhurnal nevrologii I psihiatrii im. S.S. Korsakova. 2009; 109 (11): 107-11 (in Russian).
32. Gunther T. The biochemical function of Mg2+ in insulin secretion, insulin signal transduction and insulin resistance. Magnes Res. 2010; 23 (1): 5-18.
33. Young G.L., Jewell D. Interventions for leg cramps in pregnancy. Cochrane Database
34. Syst Rev. 2002; 1: CD000121. 34. Makrides M., Crowther C.A. Magnesium supplementation in pregnancy. Cochrane Database Syst Rev. 2001; 4: CD000937.
35. Gromova O.A., Torshin I.Yu., Pronin A.V. et al. Meta-analysis of efficacy and safety of organic magnesium salts use in obstetric practice [Meta-analiz effektivnosti i bezopasnosti primeneniya organicheskij solej magniya v akusherskoj praktike]. Akusherstvo i ginekologiya. 2014; 10: 33-40 (in Russian).
36. Belotserkovtseva L.D., Kovalenko L.V., Kasparova A.E. Pathogenetic mechanisms of cardioplacental insufficiency formation in intrauterine infection and preeclampsia [Patogeneticheskie mekhanizmy formirovaniya kardioplacentarnoj nedostatochnosti pri vnutriutrobnom inficirovanii i preehklampsii]. Voprosy ginekologii, akusherstva i perinatologii. 2014; 13 (2): 23-6 (in Russian).
37. Jobava E.M., Ilina I.Yu., Chikisheva A.A. et al. New approaches to correction of thrombophilic hemostasis disorders during pregnancy. The role of magnesium. Effectiveness of therapy and combined effects [Novye podhody k korrekcii trombofilicheskih narushenij gemostaza vo vremya beremennosti. Rol' magniya. Effektivnost' terapii i sochetannye effekty]. Ginekologiya. 2012; 5: 55-9 (in Russian).
38. Esenova Zh.E. Application of Magne B6 during pregnancy and prenatal period [Primenenie Magne B6 pri beremennosti i predrodovom periode]. Medicinskij zhurnal zapadnogo Kazahstana. 2010; 3 (27): 149-51 (in Russian).
39. Kerimkulova N.V., Nikiforova N.V., Sonina N.P. et al. Effect of magnesium citrate on the course of pregnancy with connective tissue dysplasia [Vliyanie citrata magniya na techenie beremennosti pri displazii soedinitel'noj tkani]. Ginekologiya. 2013; 5: 76-82 (in Russian).
40. Lukina T.S., Pavlov O.G., Kozina E.A. Management of pregnant women with undifferentiated connective tissue dysplasia [Vedenie beremennyh zhenshchin s nedifferencirovannoj displaziej soedinitel'noj tkani]. Vestnik novyh medicinskih tekhnologij. 2015; 4: 2-5. URL: http://www.medtsu.tula.ru/ (in Russian) [Accessed: 10.08.2017].
41. Kosheleva N.G., Nikologorskaya E.V. Preventive application of Magne-B6 in pregnant women with arterial hypertension and obesity, suffering from miscarriage [Profilakticheskoe primenenie Magne-B6 u beremennyh zhenshchin s arterial'noj gipertoniej i ozhireniem, stradayushchih nevynashivaniem beremennosti]. Ginekologiya. 2010; 3: 35-8 (in Russian).
42. Sidorova I.S., Unanyan A.L. Complex prevention of preeclampsia in pregnant high-risk groups with the use of organic magnesium salts in combination with pyridoxine [Kompleksnaya profilaktika preehklampsii u beremennyh gruppy vysokogo riska s primeneniem organicheskih solej magniya v sochetanii s piridoksinom]. Rossijskij vestnik akushera-ginekologa. 2013; 4 (13):74-8 (in Russian).
43. About Plenum of the Presidium of Russian Society of Obstetricians and Gynecologists [O Plenume Prezidiuma Rossijskogo obshchestva akusherov-ginekologov]. Akusherstvo i ginekologiya. 2015; 5: 113-5 (in Russian).
44. Obstetrics: national guideline [Akusherstvo: nacional'noe rukovodstvo (Pod red. G.M. Savel'evoj, G.T. Suhih, V.N. Serova, V.E. Radzinskogo)]. Moskva: GEOTAR-Media. 2015: 1080 s (in Russian).
45. Obstetrics and gynecology. Clinical recommendations [Akusherstvo i ginekologiya. Klinicheskie rekomendacii (Pod red. G.M. Savel'evoj, V.N. Serova, G.T. Suhih)]. Moskva: GEOTAR-Media. 2016: 1024 s (in Russian).
46. A guide to outpatient care in obstetrics and gynecology [Rukovodstvo po ambulatornopoliklinicheskoj pomoshchi v akusherstve i ginekologii (Pod red. V.N. Serova, G.T. Suhih, V.N. Prilepskoj, V.E. Radzinskogo)]. Moskva: GEOTAR-Media. 2016: 1136 s (in Russian).
47. Resolution of National Meeting «Multidisciplinary Approach to the Correction of Magnesium-deficient States», September 12, 2015 (Moscow) [Rezolyuciya Nacional'nogo soveshchaniya «Mul'tidisciplinarnyj podhod k korrekcii magnij-deficitnyh sostoyanij» ot 12 sentyabrya 2015 g. (Moskva)]. Akusherstvo i ginekologiya. 2015; 11: 131 (in Russian).
48. Dizhevskaya E.V. Exchange of scientific data and expert opinions on pharmacotherapy during pregnancy: traditional and modern approaches [Obmen nauchnymi dannymi i ekspertnymi mneniyami po farmakoterapii v techenie beremennosti: tradicionnye i sovremennye podhody]. Akusherstvo, ginekologiya i reprodukciya. 2015; 9 (4): 93-101 (in Russian).
49. Magne B6 ® (Magne B6 ®): Film-coated tablets. Instructions for medical use. Magne B6 ® forte (Magne B6 ® forte): Film-coated tablets. Instructions for medical use. Magne B6 ® (Magne B6 ®): Solution for oral administration. Instructions for medical use [Magne B6 ® (Magne B6 ®): Tabletki, pokrytye obolochkoj. Instrukciya po medicinskomu primeneniyu. Magne B6 ® forte (Magne B6 ® forte): Tabletki, pokrytye plenochnoj obolochkoj. Instrukciya po medicinskomu primeneniyu. Magne B6 ® (Magne B6 ®): Rastvor dlya priema vnutr'. Instrukciya po medicinskomu primeneniyu]. RLS. 2016. URL: http://www.rlsnet.ru/ (in Russian) [Accessed: 10.08.2017].
50. Gromova O.A., Limanova O.A. Magnesium Deficiency and Muscle Cramps in Pregnant Women: The Possibilities of Therapy (Clinico-Pharmacological Lecture) [Deficit magniya i sudorogi myshc u beremennyh: vozmozhnosti terapii (kliniko-farmakologicheskaya lekciya). Ginekologiya. 2014; 2: 70-7 (in Russian).
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For citations:
Dikke G.B. USE OF MAGNESIUM IN OBSTETRICS: MYTHS AND FACTS. Obstetrics, Gynecology and Reproduction. 2017;11(3):59-68. (In Russ.) https://doi.org/10.17749/2313-7347.2017.11.3.059-068
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