KLINICKÁ FARMAKOLOGIE A FARMACIE / Klin Farmakol Farm. 2024;38(3):100-106 / www.klinickafarmakologie.cz 102 HLAVNÍ TÉMA Importance and safety of magnesium supplementation in pregnancy. To supplement or not? Assessment of magnesium status in pregnancy To evaluate magnesium status, serum magnesium concentration (5) can be used, or other methods such as measuring magnesium concentration in erythrocytes, saliva, and urine. Laboratory tests and clinical assessment are recommended for overall evaluation (22). According to Morton, A., (2018), serum magnesium concentrations in the preconception time range from 0.62 to 0.95 (mmol/l), and in the first, second, and third trimesters, their values are 0.65–0.9 (mmol/l), 0.62–0.9 (mmol/l), and 0.45–0.9 (mmol/l), respectively (3). Maternal hypomagnesaemia and clinical manifestations The deficiency, depending on the rate and factors contributing to magnesium loss (11), can manifest as nonspecific (11) and can be similar to other electrolyte imbalances (11), but can also manifest specifically. Tab. 2. Overview of the aetiology of magnesium deficiency in pregnancy or in the preconception period Aetiology General population and pregnant women Detailed information genetic aetiology G G G G hypercalciuric hypomagnesaemias40 Gitelman-like hypomagnesaemias40 mitochondrial hypomagneasemias40 other genetic hypomagnesaemias40 aetiology of use of addictive substances G addictive substance use (heroin, morphine, cocaine, nicotine, alcohol, caffeine, or other addictive substances)41 nutritional deficiency or overnutrition G G P G G unmet nutritional or dietary requirements14 parenteral nutrition14, 42 malnutrition3 starvation42 diet high in fat or sugar43 gastrointestinal aetiology G G, P G, P G G G G fistulas14, vomiting14 diarrhoea3, 14, 42 malabsorption3, 14 acute pancreatitis14, 42 (Note: can also be classified into section- transfer from the extracellular to the intracellular compartment) gastric bypass surgery42 liver disorders43 renal losses G G G familial: genetic aetiology14 acquired: from therapeutic agents14 other acquired tubular dysfunctions and diseases42, 44 endocrine aetiology G, P G G G G, P G, P hypercalcaemia3, 14, 44 (reduced NaCl reabsorption) primary hyperparathyroidism44 malignant hypercalcaemia44 hyperthyroidism44 hyperaldosteronism (reduced NaCl reabsorption)3, 44 osmotic polyuria – poorly controlled diabetes mellitus3, 44 transfer from the extracellular to the intracellular compartment G G G G G G G treatment of diabetic ketoacidosis with insulin42 refeeding syndrome14, 42, 44 correction of metabolic acidosis42, 44 ethanol withdrawal syndrome42 hungry bone syndrome42 – a state of profound hypocalcaemia14 catecholamine excess44 significant blood transfusion44 use of therapeutic agents G G G, P G G G, P G G G G G proton pump inhibitors14, 42 aminoglycoside antibiotics14, 42, 44 loop and thiazide diuretics3, 14, 42 ,44 monoclonal antibodies – cetuximab and others42 amphotericin B14, 42 cytotoxic drugs: cisplatin3, 14, 42, 44 certain antitubercular drugs44 beta-adrenergic agonists: theophylline, salbutamol44 digitalis42 antacids43 laxatives43 pregnancy and puerperal aetiology P excessive lactation3 other factors G G G G G G G stress45 sweating43, exercise43 oestrogen therapy43 low salt intake43 low selenium intake43 vitamin B6 deficiency43 vitamin D hypervitaminosis or hypovitaminosis43 Note: endocrine aetiology can overlap with renal aetiology. Sign: G indicates that information was mainly retrieved from available information from the general population. Sign: P indicates causes of hypomagnesaemia relevant to pregnancy data.
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