Magnesium sulfate for neuroprotection before preterm birth: Uptake and adherence in clinical practice after National Guideline Implementation
In brief
83% of eligible preterm births receive magnesium sulfate for neuroprotection
In Denmark, 83% of women delivering between 24 and 32 weeks got magnesium sulfate after a 2020 national guideline, but only 71% received it within 24 hours of birth. Uptake was near universal before 28 weeks but fell to about 80% after that, with larger hospitals performing better. Persistent gaps suggest targeted education is needed to ensure all eligible infants benefit.
- Journal
- Acta obstetricia et gynecologica Scandinavica (Q1)
- Published
- 3 September 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Hanne Trap Wolf, Sofie Elise Gellert, Lene Drasbek Huusom, Mads Langager Larsen
- PMID
- 42693396
- DOI
- 10.1111/aogs.70348
Why clinicians should know about it
- Picked for Neonatology (paper of the day, 8 September 2026): Magnesium sulfate uptake for neuroprotection before preterm birth
Abstract
INTRODUCTION: Magnesium sulfate (MgSO4) administered before very preterm birth reduces the risk of cerebral palsy in surviving infants and is recommended in international guidelines. In April 2020, a national guideline for MgSO4 for fetal neuroprotection was introduced in Denmark. We evaluated clinical uptake and adherence following guideline implementation. MATERIAL AND METHODS: This retrospective medical chart review study included women who delivered at gestational age 24 + 0 to 31 + 6 weeks of gestation at nine different Danish hospitals between April 2020 and December 2023. These departments handled around 50% of all deliveries in Denmark in this period. Data were obtained from electronic medical records. The primary outcome was administration of MgSO4 for fetal neuroprotection among eligible women. Secondary outcomes included temporal trends in uptake, differences by gestational age and hospital size, and documented reasons for non-administration. Descriptive statistics were used to summarize uptake rates and patient characteristics, and comparisons were performed using appropriate statistical tests. RESULTS: A total of 583 eligible women were included. Overall, 481 women (83%) received MgSO4 for fetal neuroprotection; of these, 340 women (71%) received MgSO4 within 24 h of birth. Uptake was highest among women delivering before 28 weeks of gestation, where MgSO4 was administered in nearly all eligible cases. Among women delivering between 28 + 0 and 31 + 6 weeks, approximately one in five did not receive treatment. Uptake did not increase over the study period, suggesting early adoption followed by stable implementation. Large-volume hospitals demonstrated higher treatment rates compared with smaller hospitals. The most frequent reasons for non-administration were lack of guideline awareness/oversight at later gestational ages and rapid delivery or maternal/fetal instability at earlier gestations. CONCLUSIONS: Following the implementation of the national guideline, uptake of MgSO4 for fetal neuroprotection in Denmark was high but incomplete. Persistent gaps in treatment, particularly among women delivering after 28 weeks of gestation, indicate a need for targeted implementation strategies to improve adherence and ensure equitable neuroprotective care.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.