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Common Preterm Labor Drug Has More Side Effects Than Alternative,,Finds Study from Packard Children's Hospital and Stanford

Preterm labor is defined as labor before 37 weeks' gestation. Although it's not always possible to prevent premature birth, physicians strive to delay delivery for at least 48 hours. The extra time allows a doctor to arrange to transfer the woman to a medical facility experienced in treating premature infants and helps maximize the effectiveness of steroids used to help the fetus to prepare for the harsh outside world.

Magnesium sulfate, nifedipine and other preterm labor treatments, called tocolytics, are thought to work by relaxing overactive uterine muscles and halting ongoing cervical changes that may lead to delivery. But it's not been clear if one is better than the others. Force of habit has dictated the use of magnesium sulfate by many physicians in the absence of a compelling reason to choose an alternative.

Lyell and El-Sayed and their collaborators randomly assigned 192 patients at Packard Children's or Santa Clara Valley Medical Center who were in preterm labor to receive either magnesium sulfate, which is an intravenous treatment, or nifedipine, an oral treatment. They found that magnesium sulfate was more effective in achieving the study's primary outcome--preventing delivery for 48 hours with uterine quiescence. But there were no significant differences in the treatments' ability to delay delivery, in the gestational age of the newborn or in the birth weight of the infants. The researchers speculate that this seeming contradiction could be explained if nifedipine, rather than stopping a woman's contractions, simply renders them clinically ineffective.

However, two-thirds of the women who received magnesium sulfate experienced mild to severe side effects such as shortness of breath and fluid build-up in the lungs during the treatment. In contrast, one-third of the women who received nifedipine experienced side effects of the treatment, including headaches. Nifedipine is commonly used to treat high blood pressure and heart disease.<
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