A global analysis found significant disparities in magnesium sulfate use for preterm birth, particularly between higher- and middle-income countries.
Use of 2 evidence-based antenatal treatments shown to reduce cerebral palsy and respiratory complications in premature infants varied widely across countries, with lower uptake observed in middle-income settings, according to a global study analysis led by researchers at the University of Bristol, and published in International Journal of Gynecology & Obstetrics.1,2
Antenatal magnesium sulfate (MgSO4) and antenatal steroids (ANS) are recommended in clinical guidelines internationally because they reduce the risk of cerebral palsy and respiratory complications in preterm babies¹. However, researchers noted that information on how consistently these interventions were implemented worldwide had been limited.1
The study was a secondary data analysis and review using routine neonatal data from babies born at 24–32 weeks’ gestation in hospitals participating in the Vermont Oxford Network (VON) dataset. Investigators analyzed 2024 data from 45,619 infants across 1,111 centers in the United Kingdom, Ireland, Austria, Switzerland, Italy, United States, United Arab Emirates, Brazil, South Africa, and India. The analysis was supplemented by United Kingdom National Neonatal Research Database data, and a literature review of 10 studies reporting on 288,631 infants.
According to the University of Bristol press release, the study examined neonatal data from over 300,000 premature births across 10 countries. Babies born before 30 weeks’ gestation face increased risks of death or serious complications, including stroke, respiratory problems, and cerebral palsy. Magnesium sulfate, when given to the mother before preterm birth, significantly reduces the risk of cerebral palsy, while antenatal steroids promote lung maturation and improve survival chances.2
The results showed substantial variation in MgSO4 use. Ireland and the UK reported the highest administration rates, exceeding 80%. In contrast, South Africa and the UAE had the lowest rates, at 33.6% and 44.5%, respectively. When stratified by national income level, higher-income countries had a mean MgSO4 implementation rate of 74.8%, compared with 49.4% in middle-income countries, with the disparity appearing not to have reduced over time.1,2
ANS use was more consistent across countries and demonstrated less variation than MgSO4 administration. The supplementary literature review found treatment rates comparable to those observed in the VON dataset.
The authors concluded that considerable international variation existed in the use of these key antenatal interventions, with notably lower uptake in middle-income countries. They called for further research to better understand the drivers of these differences and to improve global equity in access to life-saving treatments.
“Our study has highlighted the international disparities in how [2] key treatments to protect pre-term babies are implemented,” said Hannah Edwards, senior research associate in Medical Statistics at the University of Bristol and ARC West. “These gaps aren’t because of a lack of evidence. Lessons can be learned from successful implementation programmes like PReCePT, which has transformed use of magnesium sulphate in pre-term births in England. The bigger-picture goal now should be to ensure that no matter where a baby is born, their mother has access to the evidence-based treatments that offer the best start in life.”2
Karen Luyt, PReCePT national clinical lead and professor of Neonatal Medicine at the University of Bristol, added: “This work highlights the power of international collaboration to achieve health equity for mothers and babies everywhere. At the moment, the use of MgSO4 to prevent cerebral palsy in pre-term infants is not equitable around the world. Our PReCePT blueprint for successful implementation of this life-changing medication will be useful for accelerating use into routine clinical practice across international healthcare systems.”
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