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Association between the administration of intrapartum magnesium and the incidence of intrapartum fever
Abstract Number: O2-01
Abstract Type: Original Research
Maternal fever, defined as a temperature ≥ 38° C (100.4° F), is associated with several adverse neonatal outcomes including hypotonia, seizures, and need for resuscitation. An association between the use of intrapartum neuraxial analgesia and maternal fever exists, possibly mediated by interleukin-6.1 In a rat model, magnesium sulfate suppressed interleukin-6-induced increases in maternal temperature. We hypothesized that patients exposed to intrapartum magnesium would have a lower incidence of fever than patients not exposed to magnesium.
In this retrospective, cross-sectional study, electronic medical record data from all live-born deliveries at Northwestern Memorial Hospital between 2007 and 2014 were evaluated. Cases without temperature data were excluded. Extracted data included parity, gestational age, labor type, membrane status at admission, mode of delivery, the use of neuraxial analgesia/anesthesia, diagnosis of preeclampsia, and whether magnesium sulfate was administered. The primary outcome was the diagnosis of fever. After initial univariable analyses, variables with a P <0.1 were entered into a multivariable model.
There were 62,646 deliveries that met inclusion criteria; 6,163 of these developed a fever (9.8%). Women who developed fever were more likely to be nulliparous, term, not preeclamptic, have used neuraxial analgesia/anesthesia, and have delivered via cesarean. The incidence of fever was lower in women who were exposed to magnesium than those who were not (4.3% vs. 9.9%, P<0.001). In a multivariable logistic regression model (Table), women exposed to magnesium were less likely to develop a fever than those who were not (adjusted odds ratio 0.58, 95% CI 0.42 to 0.81).
Our data suggest that magnesium may play a protective role against the development of maternal fever. Future work should evaluate the association between the duration of magnesium administration and the development of fever, as well as evaluate neonatal outcomes. These findings should be validated in prospective study, in order to inform the use of magnesium as a potential intervention.
1. Goetzl L et al. Am J Obstet Gynecol 2002;187:834-8.