I am encouraged in my previous review manuscript entitled “New insights into the role of aminopeptidases in the treatment for both preeclampsia and preterm labor”, which appeared in Expert Opin Investig Drugs. 2013;22: 1425-23 by Dr. Robert Mittendorf Professor, Emeritus Loyola University Chicago as follows:
Hello Shige, 29/10.13
Thank you for sending this 'dynamite' article to me. In my view, "Expert Opinion" is an excellent publication outlet. Their editors also published one of my manuscripts several years ago: Pryde PG, Janeczek S, Mittendorf R. Risk-benefit effects of tocolytic therapy. Expert Opin Drug Saf 2004;3:639-54.
With best regards, Robert
Robert Mittendorf, MD, DrPH
Professor, Emeritus
Loyola University Chicago
He warned against use of both magnesium sulfate and the beta-2mimetics for preterm labor.
He emphasized in his article (Expert Opin. Drug Saf. 2004;3:639-654 ) his concern about conventional tocolytic drugs such as beta 2 stimulant and magnesium sulfate on both fetus and mother. Briefly I will introduce his concern as follows: Disappointingly,his interpretations of the current literature, and his clinical experience , lead him to the conclusion that some of the still popular tocolytics reviewed have considerable, and in some cases
unacceptable, potential for maternal and /or fetal toxicity. For example, both magnesium sulfate and the beta-2mimetics share substantial potential contribution to maternal harm at tocolytic doses. In fact, each has been implicated in maternal deaths among previously healthy women treated aggressively for preterm labor. Moreover, magnesium sulfate, still American’s favourite tocolytics, now has mounting, and increasing convincing evidence of substantial fetal toxicity.
As with many questions in medicine, there are not yet sufficient data to propose definitive evidence-based guidelines regarding tocolysis. Nonetheless, clinicians are forced regularly with premature labour and must make management decisions despite such scientific limitations.
Magnesium sulfate has now been sufficiently, but also a considerable potential for maternal and fetal/neonatal toxicity at the extreme doses typically employed for tocolysis. Accordingly, we see no rationale for its use further consideration in either contemporary tocolytic research, or in the daily clinical management of premature labour.
We should take care consideration on his warning much more.