A comparison of magnesium sulfate and nimodipine for the prevention of eclampsia

Michael A. Belfort, John Anthony, George Saade, John C. Allen

Research output: Contribution to journalArticle

188 Citations (Scopus)

Abstract

OBJECTIVE: Magnesium sulfate may prevent eclampsia by reducing cerebral vasoconstriction and ischemia. Nimodipine is a calcium-channel blocker with specific cerebral vasodilator activity. Our objective was to determine whether nimodipine is more effective than magnesium sulfate for seizure prophylaxis in women with severe preeclampsia. METHODS: We conducted an unblinded, multicenter trial in which 1650 women with severe preeclampsia were randomly assigned to receive either nimodipine (60 mg orally every 4 hours) or intravenous magnesium sulfate (given according to the institutional protocol) from enrollment until 24 hours post partum. High blood pressure was controlled with intravenous hydralazine as needed. The primary outcome measure was the development of eclampsia, as defined by a witnessed tonic - clonic seizure. RESULTS: Demographic and clinical characteristics were similar in the two groups. The women who received nimodipine were more likely to have a seizure than those who received magnesium sulfate (21 of 819 [2.6 percent] vs. 7 of 831 [0.8 percent], P=0.01). The adjusted risk ratio for eclampsia associated with nimodipine, as compared with magnesium sulfate, was 3.2 (95 percent confidence interval, 1.1 to 9.1). The antepartum seizure rates did not differ significantly between groups, but the nimodipine group had a higher rate of postpartum seizures (9 of 819 [1.1 percent] vs. 0 of 831, P=0.01). There were no significant differences in neonatal outcome between the two groups. More women in the magnesium sulfate group than in the nimodipine group needed hydralazine to control blood pressure (54.3 percent vs. 45.7 percent, P<0.001). CONCLUSIONS: Magnesium sulfate is more effective than nimodipine for prophylaxis against seizures in women with severe preeclampsia.

Original languageEnglish (US)
Pages (from-to)304-311
Number of pages8
JournalNew England Journal of Medicine
Volume348
Issue number4
DOIs
StatePublished - Jan 23 2003

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Magnesium Sulfate
Nimodipine
Eclampsia
Seizures
Pre-Eclampsia
Hydralazine
Calcium Channel Blockers
Vasoconstriction
Brain Ischemia
Vasodilator Agents
Postpartum Period
Multicenter Studies
Odds Ratio
Demography
Outcome Assessment (Health Care)
Confidence Intervals
Blood Pressure
Hypertension

ASJC Scopus subject areas

  • Medicine(all)

Cite this

A comparison of magnesium sulfate and nimodipine for the prevention of eclampsia. / Belfort, Michael A.; Anthony, John; Saade, George; Allen, John C.

In: New England Journal of Medicine, Vol. 348, No. 4, 23.01.2003, p. 304-311.

Research output: Contribution to journalArticle

Belfort, Michael A. ; Anthony, John ; Saade, George ; Allen, John C. / A comparison of magnesium sulfate and nimodipine for the prevention of eclampsia. In: New England Journal of Medicine. 2003 ; Vol. 348, No. 4. pp. 304-311.
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AB - OBJECTIVE: Magnesium sulfate may prevent eclampsia by reducing cerebral vasoconstriction and ischemia. Nimodipine is a calcium-channel blocker with specific cerebral vasodilator activity. Our objective was to determine whether nimodipine is more effective than magnesium sulfate for seizure prophylaxis in women with severe preeclampsia. METHODS: We conducted an unblinded, multicenter trial in which 1650 women with severe preeclampsia were randomly assigned to receive either nimodipine (60 mg orally every 4 hours) or intravenous magnesium sulfate (given according to the institutional protocol) from enrollment until 24 hours post partum. High blood pressure was controlled with intravenous hydralazine as needed. The primary outcome measure was the development of eclampsia, as defined by a witnessed tonic - clonic seizure. RESULTS: Demographic and clinical characteristics were similar in the two groups. The women who received nimodipine were more likely to have a seizure than those who received magnesium sulfate (21 of 819 [2.6 percent] vs. 7 of 831 [0.8 percent], P=0.01). The adjusted risk ratio for eclampsia associated with nimodipine, as compared with magnesium sulfate, was 3.2 (95 percent confidence interval, 1.1 to 9.1). The antepartum seizure rates did not differ significantly between groups, but the nimodipine group had a higher rate of postpartum seizures (9 of 819 [1.1 percent] vs. 0 of 831, P=0.01). There were no significant differences in neonatal outcome between the two groups. More women in the magnesium sulfate group than in the nimodipine group needed hydralazine to control blood pressure (54.3 percent vs. 45.7 percent, P<0.001). CONCLUSIONS: Magnesium sulfate is more effective than nimodipine for prophylaxis against seizures in women with severe preeclampsia.

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