Does MgSO4 Treatment Affect Maternal Aspartate Aminotransferase to Platelet Ratio Index (APRI) Score in Preterm Labor?

Yıl 2023, Cilt: 5 Sayı: 3, 644 - 7, 18.09.2023

Ebru Yüce

https://doi.org/10.37990/medr.1335544

Öz

Aim: This study evaluated the association between magnesium sulfate treatment for fetal neuroprotection on APRI scores in pregnant women with the preterm birth threat.
Material and Methods: Thirty-one pregnant women hospitalized and received MgSO4 for preterm birth risk in the Obstetrics and Gynecology Department, between 2019-2022 were included, and the patient records were evaluated retrospectively. The fetal neuroprotective MgSO4 treatment protocol included administering a loading infusion dose of 4 grams/30 minutes followed by a 1 gram/hour infusion for 24 hours to pregnant women hospitalized for a threat of preterm labor. In addition, the electrocardiography, hemogram, and hepatic and renal functions were evaluated upon hospitalization before MgSO4 administration, and patients were monitored closely. Women who gave birth before completion of 24 hours of MgSO4 administration, multiple pregnancies, patients with comorbid deteriorated liver or kidney functions, preeclampsia, intrauterine growth retardation, fetal abnormalities, gestational diabetes mellitus, chorioamnionitis, adolescent and advanced age pregnancies or any other obstetric complications were excluded from analyses. The APRI score was calculated and compared between the results of the biochemical analyses performed at initiation (basal) and 12th hour of MgSO4 administration.
Results: The mean APRI score at the 12th hour of administration (0.45±0.07) was significantly higher than the basal values (0.31±0.07) (p<0.001), but hemoglobin, hematocrit, and platelet values were similar (p>0.05 for all).
Conclusions: Magnesium sulfate treatment for preterm birth threat significantly increases APRI score at the 12th hour of administration.

Anahtar Kelimeler

apri score , MgSO4 treatment , neuroprotective effect , preterm birth

Kaynakça

• 1. Frey HA, Klebanoff MA. The epidemiology, etiology, and costs of preterm birth. Semin Fetal Neonatal Med. 2016;21:68-73.
• 2. Walani SR. Global burden of preterm birth. Int J Gynaecol Obstet. 2020;150:31-3.
• 3. Sen C. Preterm labor and preterm birth. J Perinat Med. 2017;45:911-3.
• 4. Costantine MM, Weiner SJ. Effects of antenatal exposure to magnesium sulfate on neuroprotection and mortality in preterm infants: a meta-analysis. Obstet Gynecol. 2009;114:354-64.
• 5. American College of Obstetricians and Gynecologists’ Committee on practice bulletins—obstetrics. Practice bulletin no. 171: management of preterm labor. Obstet Gynecol. 2016;128:e155-64.
• 6. Wolf HT, Henriksen TB, Larsen ML, et al. Magnesium sulphate treatment decreases the risk of cerebral palsy after preterm birth. Ugeskr Laeger. 2020;182:V06200441.
• 7. Shmagel KV, Saidakova EV, Shmagel NG, et al. Systemic inflammation and liver damage in HIV/hepatitis C virus coinfection. HIV Med. 2016;17:581-9.
• 8. Vilar-Gomez E, Chalasani N. Non-invasive assessment of non-alcoholic fatty liver disease: clinical prediction rules and blood-based biomarkers. J Hepatol. 2018;68:305-15.
• 9. Tolunay HE, Kahraman N, Varlı EN, et al. First-trimester aspartate aminotransferase to platelet ratio index in predicting intrahepatic cholestasis in pregnancy and its relationship with bile acids: a pilot study. Eur J Obstet Gynecol Reprod Biol. 2021;256:114-7.
• 10. Tolunay HE, Kahraman NC, Varli EN, et al. Can first-trimester AST to platelet ratio index scores predict HELLP syndrome?. J Coll Physicians Surg Pak. 2021;31:188-92.
• 11. Jayaram PM, Mohan MK, Farid I, Lindow S. Antenatal magnesium sulfate for fetal neuroprotection: a critical appraisal and systematic review of clinical practice guidelines. J Perinat Med. 2019;47:262-9.
• 12. Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518-26.
• 13. Galinsky R, Dean JM, Lingam I, et al. A systematic review of magnesium sulfate for perinatal neuroprotection: what have we learnt from the past decade?. Front Neurol. 2020;11:449.
• 14. Keepanasseril A, Maurya DK, Manikandan K, et al. Prophylactic magnesium sulphate in prevention of eclampsia in women with severe preeclampsia: randomised controlled trial (PIPES trial). J Obstet Gynaecol. 2018;38:305-9.
• 15. Lin CY, Tsai PS, Hung YC, Huang CJ. L-type calcium channels are involved in mediating the anti-inflammatory effects of magnesium sulphate. Br J Anaesth. 2010;104:44-51.
• 16. Sugimoto J, Romani AM, Valentin-Torres AM, et al. Magnesium decreases inflammatory cytokine production: a novel innate immunomodulatory mechanism. J Immunol. 2012;188:6338-46.
• 17. da Silva Lima F, da Rocha Romero AB, Hastreiter A, et al. An insight into the role of magnesium in the immunomodulatory properties of mesenchymal stem cells. J Nutr Biochem. 2018;55:200-8.
• 18. Suzuki-Kakisaka H, Sugimoto J, Tetarbe M, et al. Magnesium sulfate increases intracellular magnesium reducing inflammatory cytokine release in neonates. Am J Reprod Immunol. 2013;70:213-20.
• 19. Beloosesky R, Khatib N, Ginsberg Y, et al. Maternal magnesium sulfate fetal neuroprotective effects to the fetus: inhibition of neuronal nitric oxide synthase and nuclear factor kappa-light-chain-enhancer of activated B cells activation in a rodent model. Am J Obstet Gynecol. 2016;215:382.e1-6.
• 20. Ginsberg Y, Khatib N, Weiss B, et al. Magnesium sulfate (MG) prevents maternal inflammation induced offspring cerebral injury evident on MRI but not via IL-1β. Neuroscience. 2017;353:98-105.
• 21. Orgul G, Agbal T, Celen S, Caglar AT. Neuroprotective magnesium sulfate administration increases maternal neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index. Arch Gynecol Obstet. 2021;303:1433-7.
• 22. Akkoca K, Yoldas H, Sit M, et al. Effects of magnesium sulphate on liver ischemia/reperfusion injury in a rat model. Experimental Biomedical Research. 2019;2:93-102.
• 23. Karhu E, Atlas SE, Gao J, et al. Intravenous infusion of magnesium sulfate is not associated with cardiovascular, liver, kidney, and metabolic toxicity in adults. J Clin Transl Res. 2018;4:47-55.
• 24. Büyükaydın B. The relationship of hemogram and inflammatory biomarkers to length of stay in hospital and clinical course in patients with COVID-19. Bezmialem Science. 2020;8:7-14.
• 25. Takaya H, Ueyama S, Osaki Y, et al. Aspartate aminotransferase to platelet ratio index has utility as a biomarker of COVID-19 severity in patients with nonalcoholic fatty liver disease. Hepatol Res. 2023. doi: 10.1111/hepr.13943.
• 26. Tolunay, H. E., & Elci, E. Importance of haemogram parameters for prediction of the time of birth in women diagnosed with threatened preterm labour. J Int Med Res. 2020;48:300060520918432.