EFFICACY OF ANTENATAL MAGNESIUM SULPHATE IN REDUCING CEREBRAL PALSY RISK: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Cerebral palsy (CP) is a leading cause of lifelong disability among preterm infants. Antenatal magnesium sulphate (MgSO₄) has emerged as a candidate neuroprotective intervention, but the magnitude and consistency of its effects remain debated.

Objective: To systematically assess the efficacy and safety of antenatal MgSO₄ in reducing CP incidence among preterm infants, through meta-analysis of randomized controlled trials (RCTs).

Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. Electronic databases (MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov) were searched through June 2025 for RCTs evaluating antenatal MgSO₄ in women at risk of preterm birth (<37 weeks gestation). Two reviewers independently screened studies, extracted data, and assessed risk of bias. The primary outcome was the incidence of cerebral palsy. Secondary outcomes included neonatal mortality and adverse maternal effects. Random-effects models were used to pool risk ratios (RRs), and certainty of evidence was assessed via GRADE.

Results: Eight RCTs comprising 6,145 infants met inclusion criteria. Antenatal MgSO₄ significantly reduced the risk of cerebral palsy (RR 0.70; 95% CI 0.56–0.87; I² = 22%). There was no significant increase in neonatal mortality (RR 1.01; 95% CI 0.89–1.15). Maternal side effects (e.g., flushing, hypotension) were transient and manageable. Overall certainty of evidence was rated high.

Conclusion: Antenatal magnesium sulphate confers a substantial neuroprotective effect in preterm infants, significantly lowering the risk of cerebral palsy without elevating mortality risk. Clinical guidelines should endorse its routine use in cases of imminent preterm birth.