Vilchez Gustavo, Dai Jing, Lagos Moraima, Sokol Robert J
a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , University of Missouri - Kansas City , Kansas City , MO , USA.
b Department of Obstetrics & Gynecology , Wayne State University School of Medicine , Detroit , MI , USA.
J Matern Fetal Neonatal Med. 2018 Jan;31(2):178-183. doi: 10.1080/14767058.2017.1279143. Epub 2017 Jan 23.
Evidence supports the need of dose-adjustment of several drugs according to body mass index (BMI) to prevent toxicity in the underweight, and ensure efficacy in obese women. However, for MgSO neuroprotection, the effect of BMI on maternal toxicity and fetal neuroprotection is understudied. We analyze the effect of BMI on maternal/infant outcomes after MgSO.
Secondary analysis of a clinical trial that studied MgSO neuroprotection. Maternal side effects, magnesium cord levels, and offspring cerebral palsy/death were analyzed along BMI strata using ANOVA and chi-square test. Logistic regression was used to calculate adjusted odds ratios according to the treatment and BMI, using nonobese that received placebo as reference. Interaction analyses were performed to validate differential efficacy of BMI.
From 2241 women, more side effects and higher magnesium cord levels were seen in underweight women (p = 0.05). MgSO neuroprotection was effective in the non-obese (p = 0.02), but not in obese women (p = 1.00). In multivariate analyses, MgSO significantly reduced cerebral palsy only in nonobese women. Interaction analyses showed the moderator effect of BMI (p = 0.169). Increasing MgSO dose in obese mothers may ensure neuroprotective efficacy without representing increased maternal risks. Considering costs of studying this association, current analysis may form the basis for reasonable practice.
有证据支持根据体重指数（BMI）调整几种药物的剂量，以预防体重过轻者的毒性反应，并确保肥胖女性的疗效。然而，对于硫酸镁的神经保护作用，BMI对母体毒性和胎儿神经保护作用的影响尚未得到充分研究。我们分析了BMI对硫酸镁治疗后母婴结局的影响。
对一项研究硫酸镁神经保护作用的临床试验进行二次分析。使用方差分析和卡方检验，分析不同BMI分层下的母体副作用、脐带血镁水平以及后代脑瘫/死亡情况。使用逻辑回归，以接受安慰剂的非肥胖者为对照，计算根据治疗和BMI调整后的比值比。进行交互分析以验证BMI的差异疗效。
在2241名女性中，体重过轻的女性出现更多副作用且脐带血镁水平更高（p = 0.05）。硫酸镁的神经保护作用在非肥胖女性中有效（p = 0.02），但在肥胖女性中无效（p = 1.00）。在多变量分析中，硫酸镁仅在非肥胖女性中显著降低了脑瘫发生率。交互分析显示了BMI的调节作用（p = 0.169）。增加肥胖母亲的硫酸镁剂量可能确保神经保护疗效，而不会增加母体风险。考虑到研究这种关联的成本，当前分析可为合理实践提供依据。
