Antenatal Magnesium Sulfate Exposure and Ponderal Index in Preterm Infants

Abstract

Objective Antenatal magnesium sulfate (MgSO₄) is known to affect the central nervous system of preterm infants, and there is biologic rationale for influence on other phenotypes. This study investigated the effect of MgSO₄ exposure on the trajectory of ponderal index (PI, kg/m³) from birth to 2 years of age.

Study Design A secondary analysis of a U.S. randomized controlled trial investigating MgSO₄ versus placebo administration among women at high risk for preterm delivery was performed. Multivariable logistic regression was used to assess the relationship between PI from birth to 2 years of age and exposure to MgSO₄ versus placebo.

Results There was a larger decrement in PI from birth to 2 years of age in infants exposed to MgSO₄ compared with placebo (p = 0.032). There was a statistically significant one-way interaction between newborn sex and treatment group (p = 0.019). Change in PI in males exhibited a greater decrement in those exposed to MgSO₄ versus placebo (p = 0.227), whereas female infants exposed to MgSO₄ had a smaller decrement (p = 0.04).

Conclusion MgSO₄ exposure in preterm infants is associated with a larger decrease in PI from birth to 2 years of age. In addition, the direction of effect of MgSO₄ on the change in PI over the first 2 years of life is different by sex.

Keywords

preterm - magnesium sulfate - ponderal index - sex-specific difference

• References

• 1 American College of Obstetricians and Gynecologists Committee on Obstetric Practice; Society for Maternal-Fetal Medicine. Committee Opinion No. 455: Magnesium sulfate before anticipated preterm birth for neuroprotection. Obstet Gynecol 2010; 115 (03) 669-671
• 2 James MFM. Magnesium in obstetrics. Best Pract Res Clin Obstet Gynaecol 2010; 24 (03) 327-337
• 3 Saris NE, Mervaala E, Karppanen H, Khawaja JA, Lewenstam A. Magnesium. An update on physiological, clinical and analytical aspects. Clin Chim Acta 2000; 294 (1-2): 1-26
• 4 Huxley R, Owen CG, Whincup PH. , et al. Is birth weight a risk factor for ischemic heart disease in later life?. Am J Clin Nutr 2007; 85 (05) 1244-1250
• 5 Araújo de França GV, Restrepo-Méndez MC, Loret de Mola C, Victora CG. Size at birth and abdominal adiposity in adults: a systematic review and meta-analysis. Obes Rev 2014; 15 (02) 77-91
• 6 Class QA, Rickert ME, Lichtenstein P, D'Onofrio BM. Birth weight, physical morbidity, and mortality: a population-based sibling-comparison study. Am J Epidemiol 2014; 179 (05) 550-558
• 7 Ong KK, Ahmed ML, Emmett PM, Preece MA, Dunger DB. Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ 2000; 320 (7240): 967-971
• 8 Ong KK, Preece MA, Emmett PM, Ahmed ML, Dunger DB. ; ALSPAC Study Team. Size at birth and early childhood growth in relation to maternal smoking, parity and infant breast-feeding: longitudinal birth cohort study and analysis. Pediatr Res 2002; 52 (06) 863-867
• 9 Oken E, Gillman MW. Fetal origins of obesity. Obes Res 2003; 11 (04) 496-506
• 10 Stark MJ, Clifton VL, Wright IM. Sex-specific differences in peripheral microvascular blood flow in preterm infants. Pediatr Res 2008; 63 (04) 415-419
• 11 Clifton VL. Review: Sex and the human placenta: mediating differential strategies of fetal growth and survival. Placenta 2010; 31 (Suppl): S33-S39
• 12 Gabory A, Roseboom TJ, Moore T, Moore LG, Junien C. Placental contribution to the origins of sexual dimorphism in health and diseases: sex chromosomes and epigenetics. Biol Sex Differ 2013; 4 (01) 5
• 13 Muralimanoharan S, Maloyan A, Myatt L. Evidence of sexual dimorphism in the placental function with severe preeclampsia. Placenta 2013; 34 (12) 1183-1189
• 14 Myatt L, Muralimanoharan S, Maloyan A. Effect of preeclampsia on placental function: influence of sexual dimorphism, microRNA's and mitochondria. Adv Exp Med Biol 2014; 814: 133-146
• 15 Walker MG, Fitzgerald B, Keating S, Ray JG, Windrim R, Kingdom JCP. Sex-specific basis of severe placental dysfunction leading to extreme preterm delivery. Placenta 2012; 33 (07) 568-571
• 16 Rouse DJ, Hirtz DG, Thom E. , et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008; 359 (09) 895-905
• 17 Black RE, Victora CG, Walker SP. , et al; Maternal and Child Nutrition Study Group. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013; 382 (9890): 427-451
• 18 Ong KK, Loos RJF. Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions. Acta Paediatr 2006; 95 (08) 904-908
• 19 Ong KK, Emmett P, Northstone K. , et al. Infancy weight gain predicts childhood body fat and age at menarche in girls. J Clin Endocrinol Metab 2009; 94 (05) 1527-1532
• 20 Poissonnet CM, Burdi AR, Garn SM. The chronology of adipose tissue appearance and distribution in the human fetus. Early Hum Dev 1984; 10 (1-2): 1-11
• 21 Spiegelman BM. Regulation of gene expression in the adipocyte: implications for obesity and proto-oncogene function. Trends Genet 1988; 4 (07) 203-207
• 22 Stokes TA, Holston A, Olsen C. , et al. Preterm infants of lower gestational age at birth have greater waist circumference-length ratio and ponderal index at term age than preterm infants of higher gestational ages. J Pediatr 2012; 161 (04) 735-741
• 23 Simhan HN, Berghella V, Iams JD. . Preterm labor and birth. In: Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore TR, Greene MF. , eds. Creasy & Resnik's Maternal-Fetal Medicine: Principles and Practices. 7th ed. Philadelphia, PA: Saunders Elsevier; 2014: 624-653
• 24 Cahill AG, Caughey AB. Magnesium for neuroprophylaxis: fact or fiction?. Am J Obstet Gynecol 2009; 200 (06) 590-594
• 25 Gray C, Vickers MH, Dyson RM, Reynolds CM, Berry MJ. Magnesium sulfate has sex-specific, dose-dependent vasodilator effects on preterm placental vessels. Biol Sex Differ 2015; 6: 22
• 26 Koch FR, Wagner CL, Jenkins DD. , et al. Sex differences in cerebral blood flow following chorioamnionitis in healthy term infants. J Perinatol 2014; 34 (03) 197-202
• 27 Knight B, Shields BM, Hill A, Powell RJ, Wright D, Hattersley AT. The impact of maternal glycemia and obesity on early postnatal growth in a nondiabetic Caucasian population. Diabetes Care 2007; 30 (04) 777-783
• 28 Regnault N, Botton J, Forhan A. , et al. Determinants of early ponderal and statural growth in full-term infants in the EDEN mother-child cohort study. Am J Clin Nutr 2010; 92 (03) 594-602