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Invitation to the Press - Magnesium Sulphate Halves Risk Of Eclampsia For Pregnant Women With Pre-eclampsia (pp 1872, 1877)

May 29, 2002

A landmark international study in this week's issue of THE LANCET highlights how magnesium sulphate can substantially reduce the chance of pregnant women who have pre-eclampsia developing the potentially fatal condition of eclampsia. The striking findings and low cost of magnesium sulphate ($5 per patient) could result in a significant change in the clinical management of pre-eclampsia worldwide.

Up to 8% of pregnant women develop pre-eclampsia (pregnancy-induced high blood pressure which can lead to eclampsia, characterised by convulsions which can cause maternal death). Eclampsia is more common in less-developed countries, and accounts for around 50,000 maternal deaths a year worldwide. Anticonvulsants are used for pre-eclampsia in the belief they prevent eclamptic convulsions; previous research has suggested that the anticonvulsant magnesium sulphate (first used in obstetric care in the USA nearly a century ago) offers the best hope for reducing the development of eclampsia among women with pre-eclampsia, but no adequate trials have been done.

Lelia Duley from the Institute for Health Sciences, Oxford, UK, led an international study-Magnesium Sulphate for Prevention of Eclampsia (Magpie)-a randomised trial where around 10,000 women from 33 countries with pre-eclampsia were randomly assigned magnesium sulphate or placebo (given intravenously or intramuscularly).

The trial was stopped early when there was conclusive evidence in favour of the intervention-magnesium sulphate more than halved the risk of eclampsia compared with placebo (overall 58% reduction in risk). Magnesium sulphate also reduced the relative risk of maternal death by 45%. A quarter of women given magnesium sulphate reported side effects compared with 5% of women given placebo.

In an accompanying Commentary-Magnesium for preventing and treating eclampsia: time for international action(p 1872)- Shirish Sheth from Mumbai, India, and Iain Chalmers from the UK Cochrane Centre, Oxford, UK, conclude: 'Women, clinicians, and researchers have now collaborated in producing reliable evidence showing that magnesium sulphate can prevent as well as control eclamptic convulsions. It is now up to those responsible for maternal health services-at local, national, and international levels-to ensure that this effective, apparently safe, and inexpensive drug is available to women everywhere when needed."

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