Bibliographic Info
GuidelineWHO recommendations on maternal health: guidelines approved by the WHO Guidelines Review Committee, second edition. Geneva: World Health Organization; 2025
Year of Publication2023
Issuing InstitutionWorld Health Organization
Recommendation
Status
Maintained
Recommended in favor
Strong
Certainty of evidence
Moderate
The use of magnesium sulfate is recommended for women at risk of imminent preterm birth before 32 weeks of gestation for prevention of cerebral palsy in the infant and child.
Notes and Remarks
- 1.Evidence suggests that the protective effects of magnesium sulfate on neurological complications (neuroprotection) are likely to be increased at earlier gestational ages.
- 2.The GDG is aware of an ongoing trial on the neuroprotective effects of magnesium sulfate at gestational ages below 34 weeks.
- 3.Magnesium sulfate for neuroprotection should only be given if preterm birth is likely within the next 24 hours. The median time from magnesium sulfate administration to birth was reported in only two of the trials that generated the evidence (1 hour 38 minutes and 3.7 hours). However, the GDG felt that administering magnesium sulfate at any time from immediately prior to birth, up to 24 hours prior to anticipated birth is appropriate
- 4.Three dosing regimens (IV 4 g over 20 minutes, then 1 g/hour until delivery or for 24 hours, whichever came first; IV 4 g over 30 minutes or IV bolus of 4 g given as single dose; and IV 6 g over 20–30 minutes, followed by IV maintenance of 2 g/hour) have been tested in the available studies, which – on meta-analysis – show effect on cerebral palsy, and death or cerebral palsy. There was insufficient evidence to recommend one specific dosing regimen over others. The GDG is aware that an individual patient data analysis of these studies is underway, which may affect this guidance in the future.
- 5.This recommendation applies to women carrying either singleton or multiple pregnancies.
- 6.In women at imminent risk of preterm birth, magnesium sulfate should be considered as the preferred option whenever there is a valid obstetric indication (e.g. pre-eclampsia) and where it is considered safe and effective.
- 7.There is a need for further research to establish whether repeated treatment with magnesium sulfate for neuroprotection is appropriate (i.e. in the event that delivery does not occur)
Also Featured In
This recommendation also appears in the following guidelines:
Originally Developed
Guideline
WHO recommendations on interventions to improve preterm birth outcomes
Year2015
InstitutionWorld Health Organization