Magnesium supplementation to prevent high blood pressure in pregnancy: a randomised placebo control trial

Abstract

Purpose

To assess if hypertension during the last part of pregnancy could be prevented by magnesium supplementation.

Methods

Pregnant primagravida women from a local antenatal care unit were given an oral supply of 300 mg magnesium as citrate or placebo from pregnancy week 25 in a randomised double-blind setup. Blood pressure was recorded during pregnancy as well as pregnancy outcome.

Results

In the magnesium-supplemented group, the average diastolic blood pressure at week 37 was significantly lower than in the placebo group (72/1.4 mean/SEM vs 77/1.4, p = 0.031). The number of women with an increase in diastolic blood pressure of ≥15 mmHg was significantly lower in the magnesium group compared with the women who received placebo (p = 0.011). There was an inverse relation between the urinary excretion of magnesium during pregnancy and the diastolic blood pressure (p = 0.005).

Conclusions

Magnesium supplementation prevented an increase in diastolic blood pressure during the last weeks of pregnancy. The relation between diastolic blood pressure and urinary excretion of magnesium suggests that magnesium is involved in the regulation of blood pressure and that the increase in diastolic blood pressure in pregnancy could be due to a lack of magnesium.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    (2000) Report of the national high blood pressure program working group on high blood pressure in pregnancy. Am J Obstet Gynecol 183:S1–S22

  2. 2.

    Backes CH, Markham K, Moorehead P, Cordero L, Nankervis CA, Giannone PJ (2011) Maternal preeclampsia and neonatal outcomes. J Pregnancy 2011:214365

    PubMed  Google Scholar 

  3. 3.

    Duley L (2009) The global impact of pre-eclampsia and eclampsia. Semin Perinatol 33:130–137

    PubMed  Article  Google Scholar 

  4. 4.

    Richie LD, King JC (2001) Dietary calcium and pregnancy-induced hypertension: is there a relation? Am J Clin Nutr 71(suppl):1371S–1374S

    Google Scholar 

  5. 5.

    Suarez VR, Trelles JG, Miyahira JM (1996) Urinary calcium in asymptomatic primigravidas who later developed preeclampsia. Obstet Gynecol 87:79–82

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Taufield PA, Ales KL, Resnick LM, Druzin ML, Gertner JM, Laragh JH (1987) Hypocalcuria in preeclampsia. New Engl J Med 316:715–718

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Trumbo PR, Ellwood KC (2007) Supplemental calcium and risk reduction of hypertension, pregnancy-induced hypertension, and preeclampsia: an evidence-based review by the US Food and Drug Administration. Nutr Rev 65:78–86

    PubMed  Article  Google Scholar 

  8. 8.

    López-Jaramillo P, Garcia RG, López M (2005) Preventing pregnancy-induced hypertension: are there regional differences for this global problem? J Hypertens 23:1121–1129

    PubMed  Article  Google Scholar 

  9. 9.

    Oken E, Ning Y, Rifas- Shiman SL, Rich-Edwards JW, Olsen SF, Gillman MW (2007) Diet during pregnancy and risk of preeclampsia or gestational hypertension. Ann Epidemiol 17:663–668

    PubMed  Article  Google Scholar 

  10. 10.

    Conradt A (1985) Pathophysiology and clinical aspects of pre-eclampsia. Z Geburtshilfe Perinatol 189:149–161

    PubMed  CAS  Google Scholar 

  11. 11.

    Jain S, Sharma P, Kulshreshtha S, Mohan G, Singh S (2010) The role of calcium, magnesium, and zinc in pre-eclampsia. Biol Trace Elem Res 133:162–170

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Indumati V, Kodliwadmath MV, Sheela MK (2011) The role of serum electrolytes in pregnancy induced hypertension. J Clin Diagnostic Res 5:66–69

    CAS  Google Scholar 

  13. 13.

    Kisters K, Barenbrock M, Louwen F, Hausberg M, Rahn KH, Kosch M (2000) Membrane, intracellular, and plasma magnesium and calcium concentrations in preeclampsia. Am J Hypertens 13:765–769

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Adam B, Malatyalioğlu E, Alvur M, Talu C (2001) Magnesium, zinc and iron levels in pre-eclampsia. J Matern Fetal Med 10:246–250

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Kisters K, Körner J, Louwen F, Witteler R, Jackisch C, Zidek W et al (1968) Plasma and membrane Ca2+ and Mg2+ concentrations in normal pregnancy and in preeclampsia. Gynecol Obstet Invest 46:158–163

    Article  Google Scholar 

  16. 16.

    Resnick LM, Barbagallo M, Bardicef M, Bardicef O, Sorokin Y, Evelhoch J et al (2004) Cellular-free magnesium depletion in brain and muscle of normal and preeclamptic pregnancy: a nuclear magnetic resonance spectroscopic study. Hypertension 44:322–326

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Idogun ES, Imarengiaye CO, Momoh SM (2007) Extracellular calcium and magnesium in preeclampsia and eclampsia. Afr J Reprod Health 11:89–94

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Duley L, Matar HE, Almerie MQ, Hal lDR (2010) Alternative magnesium sulphate regimens for women with pre-eclampsia and eclampsia. Cochrane Database Syst Rev 8:CD0077388:1

    Google Scholar 

  19. 19.

    McDonald SD, Lutsiv O, Dzaja N, Duley L (2012) A systematic review of maternal and infant outcomes following magnesium sulfate for pre-eclampsia/eclampsia in real-world use. Int J Gynecol Obstetr 118:90–96

    Article  CAS  Google Scholar 

  20. 20.

    Sugimoto J, Romani AM, Valentin-Torres AM, Luciano AA, Ramirez-Kitchen CM, Funderburg N, Mesiano S et al (2012) Magnesium decreases inflammatory cytokine production: a novel innate immunomodulatory mechanism. J Immunol 188:6338–6346

    Google Scholar 

  21. 21.

    Amash A, Weintraub AY, Sheiner E, Zeadna A, Huleihel M, Holcberg G (2010) Possible therapeutic effect of magnesium sulphate in pre-eclampsia by the down-regulation of placental tumor necrosis factor-alpha secretion. Eur Cytokine Netw 1:58–64

    Google Scholar 

  22. 22.

    Amash A, Holcberg G, Sheiner E, Huleihel M (2010) Magnesium sulfate normalizes placental interlukin-6 secretion in preeclampsia. J Interferon Cytokine Res 30:683–690

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Rudnicki M, Frolich A, Fischer-Rasmussen W, McNair P (1991) The effect of magnesium on maternal blood pressure in pregnancy-induced hypertension—a randomised double-blind placebo-controlled trial. Acta Obstet Gynecol 70:445–450

    Article  CAS  Google Scholar 

  24. 24.

    Sibai BM, Villar MA, Brazy E (1989) Magnesium supplementation during pregnancy: a double-blind randomized controlled clinical trial. Am J Obstetr Gynecol 161:115–119

    Article  CAS  Google Scholar 

  25. 25.

    Kovács L, Molnár BG, Huhn E, Bódis L (1998) Magnesium substitution in pregnancy. A prospective, randomized double-blind study. Geburtshilfe Frauenheilkd 48:595–600

    Article  Google Scholar 

  26. 26.

    Makrides M, Crowther CA (2001) Magnesium supplementation in pregnancy. Cochrane Database Syst Rev (4):CD000937. doi:10.1002/14651858.CD000937

  27. 27.

    Nielsen TF, Rylander R (2011) Urinary calcium and magnesium excretion relates to increased blood pressure during pregnancy. Arch Gynecol Obstetr 283:443–447

    Article  CAS  Google Scholar 

  28. 28.

    Rylander R, Tallheden T, Vormann J (2009) Acid–base conditions regulate calcium and magnesium homeostasis. Magnesium Res 22:1–4

    Google Scholar 

  29. 29.

    Rylander R, Remer T, Berkemeyer S, Vormann J (2006) Acid–base status affects renal magnesium losses in healthy, elderly persons. J Nutrition 36:2374–2377

    Google Scholar 

  30. 30.

    Remer T (2001) Influence of nutrition on acid–base balance—metabolic aspects. Eur J Nutr 40:214–220

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Chiuve SE, Korngold EC, Januzzi JL, Gantzer ML, Albert CM (2010) Plasma and dietary magnesium and risk of sudden cardiac death in women. Am J Clin Nutr 93:253–260. doi:10.3945/ajcn.110.002253

    PubMed  Article  Google Scholar 

  32. 32.

    Jee SH, Miller ER, Guallar E, Singh VK, Appel LJ, Klag MJ (2002) The effect of magnesium supplementation on blood pressure: a meta-analysis of randomized clinical trials. Am J Hypertens 15:691–696

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgments

The study was supported by grants from the Research and Development Foundation at Södra Älvsborg, Alice Swenzon’s Foundation, Swedbank Sjuhärad Research Foundation, Sweden, and Protina GmbH, Ismaning, Germany.

Ethical Standard

Ethical committee approval was obtained (ECG T 515-10, 098-09, Ethical Committee, Gothenburg University 8 April 2009) as well as permission to register according to Swedish law on personal information. Informed consent was obtained from all participants. Registration at ISRCTN98365455.

Conflict of interest

The authors report no conflict of interest. Dr Vormann is a scientific consultant to Protina GmbH.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Ragnar Rylander.

Additional information

Trial registration number: ISRCTN 98365455. www.controlled-trials.com.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bullarbo, M., Ödman, N., Nestler, A. et al. Magnesium supplementation to prevent high blood pressure in pregnancy: a randomised placebo control trial. Arch Gynecol Obstet 288, 1269–1274 (2013). https://doi.org/10.1007/s00404-013-2900-2

Download citation

Keywords

  • Pregnancy-induced hypertension
  • Magnesium
  • Prevention