Vilchez Gustavo, Dai Jing, Kumar Komal, Mundy David, Kontopoulos Eftichia, Sokol Robert J
a Department of Obstetrics and Gynecology , University of Missouri - Kansas City School of Medicine , Kansas City , MO , USA.
b Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA.
J Matern Fetal Neonatal Med. 2018 Sep;31(17):2304-2311. doi: 10.1080/14767058.2017.1342795. Epub 2017 Oct 4.
Despite known racial disparities in obstetrics, as well as differences in magnesium pharmacodynamics according to race, the effect of race/ethnicity in magnesium sulfate (MgSO) use during pregnancy has not been studied. Whether some mothers are at increased risk of side effects, or infants at decreased neuroprotective effects is unknown. We analyze the effect of race/ethnicity in maternal/infant outcomes after MgSO neuroprotection.
Subgroup analysis of a multicenter clinical trial (BEAM trial) where pregnant women at risk of preterm birth were randomized to either MgSO or placebo. For this study, nonanomalous singleton pregnancies were studied. The effect of race in maternal/neonatal outcomes after MgSO was analyzed with Breslow-Day and multifactorial ANOVA. Logistic regression was used to calculate odds ratios (OR) of complications according to race.
922 MgSO and 972 placebo cases were included (45.0% African-American, 36.2% Caucasian, 17.8% Hispanics, and 1.0% Asians). Interaction analysis showed a significant effect of race/ethnicity (p = .043). Hispanics presented the highest frequency (88.3%, p < .001), as well as the highest odds of MgSO side effects [OR(95%CI) = 6.6 (1.3-33.8)].
Hispanics present increased risk of magnesium toxicity compared to other racial/ethnic groups. Whether specific racial/ethnic groups require closer surveillance for early signs of magnesium toxicity needs to be further explored.
尽管已知产科领域存在种族差异，且镁的药效学因种族而异，但种族/族裔对孕期硫酸镁（MgSO）使用的影响尚未得到研究。一些母亲出现副作用的风险增加，或者婴儿获得的神经保护作用降低，其情况尚不清楚。我们分析了种族/族裔对硫酸镁神经保护后母婴结局的影响。
对一项多中心临床试验（BEAM试验）进行亚组分析，该试验将有早产风险的孕妇随机分为硫酸镁组或安慰剂组。在本研究中，纳入了非畸形单胎妊娠。采用Breslow-Day检验和多因素方差分析，分析种族对硫酸镁治疗后母婴结局的影响。使用逻辑回归计算不同种族并发症的比值比（OR）。
共纳入922例硫酸镁病例和972例安慰剂病例（非裔美国人占45.0%，白种人占36.2%，西班牙裔占17.8%，亚洲人占1.0%）。交互分析显示种族/族裔有显著影响（p = 0.043）。西班牙裔出现硫酸镁副作用的频率最高（88.3%，p < 0.001），且出现副作用的几率也最高[OR(95%CI) = 6.6(1.3 - 33.8)]。
与其他种族/族裔群体相比，西班牙裔出现镁中毒的风险增加。特定种族/族裔群体是否需要更密切监测镁中毒的早期迹象，有待进一步探索。
