Timing of Magnesium Sulfate Cessation and Apnea of Prematurity in Late-Preterm Twin Infants.
To evaluate the association between the timing of maternal magnesium sulfate (MgSO4) discontinuation before delivery and the risk of apnea of prematurity (AOP) in late-preterm twin infants.
This retrospective cohort study included 161 twin pregnancies (322 infants) delivered between 34 0/7 and 36 6/7 weeks at Yamanashi Prefectural Central Hospital (2017-2025). Infants with major anomalies or intrauterine fetal demise were excluded. The primary exposure was the interval between MgSO4 cessation and delivery, categorized as: no exposure, < 12, 12-24, and ≥ 24 h. Two multivariable logistic regression models were constructed. Model 1 evaluated the association between any maternal MgSO4 exposure and AOP. Model 2 further incorporated the timing of MgSO4 discontinuation as a categorical exposure, adjusting for gestational age, chorionicity, small-for-gestational-age status, sex, and 1-min Apgar score.
Among the 322 infants, 112 (34.8%) developed AOP. In Model 1, maternal MgSO4 exposure itself was not significantly associated with AOP. However, in Model 2, delivery within 12 h after cessation of MgSO4 was independently associated with AOP (adjusted odds ratio, 7.44; 95% confidence interval, 1.48-37.4), whereas longer discontinuation intervals (12-24 or ≥ 24 h) were not.
Among late-preterm twin infants, maternal MgSO4 exposure itself was not independently associated with AOP; however, delivery soon after MgSO4 discontinuation was associated with an increased risk of AOP. These findings support consideration of MgSO4 discontinuation timing in perinatal risk assessment and neonatal respiratory monitoring and may help guide future studies.
This retrospective cohort study included 161 twin pregnancies (322 infants) delivered between 34 0/7 and 36 6/7 weeks at Yamanashi Prefectural Central Hospital (2017-2025). Infants with major anomalies or intrauterine fetal demise were excluded. The primary exposure was the interval between MgSO4 cessation and delivery, categorized as: no exposure, < 12, 12-24, and ≥ 24 h. Two multivariable logistic regression models were constructed. Model 1 evaluated the association between any maternal MgSO4 exposure and AOP. Model 2 further incorporated the timing of MgSO4 discontinuation as a categorical exposure, adjusting for gestational age, chorionicity, small-for-gestational-age status, sex, and 1-min Apgar score.
Among the 322 infants, 112 (34.8%) developed AOP. In Model 1, maternal MgSO4 exposure itself was not significantly associated with AOP. However, in Model 2, delivery within 12 h after cessation of MgSO4 was independently associated with AOP (adjusted odds ratio, 7.44; 95% confidence interval, 1.48-37.4), whereas longer discontinuation intervals (12-24 or ≥ 24 h) were not.
Among late-preterm twin infants, maternal MgSO4 exposure itself was not independently associated with AOP; however, delivery soon after MgSO4 discontinuation was associated with an increased risk of AOP. These findings support consideration of MgSO4 discontinuation timing in perinatal risk assessment and neonatal respiratory monitoring and may help guide future studies.
Authors
Shinohara Shinohara, Yasuda Yasuda, Kasai Kasai, Katsumata Katsumata, Nemoto Nemoto, Naito Naito, Sunami Sunami
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