www.klinickafarmakologie.cz / Klin Farmakol Farm. 2024;38(3):100-106 / KLINICKÁ FARMAKOLOGIE A FARMACIE 105 HLAVNÍ TÉMA Importance and safety of magnesium supplementation in pregnancy. To supplement or not? increased risk that intravenous administration can lead to the development of foetal skeletal demineralization and hypocalcaemia which can occur after the fifth day of administration (38, 56). These limitations are not related to the oral form (56). Recommendations whether to supplement or not Approximately half of the women in the United Kingdom and the United States of America between 19 and 50 years old do not meet the requirements for magnesium intake (61), and during pregnancy, a 10% higher supply of magnesium is required (2). Normomagnesaemia may not rule out magnesium deficiency (4). Maternal hypomagnesaemia has clinical symptoms, but may also occur without clinical symptoms (56). Oral form of magnesium is safer than parenteral administration, which has limitations and belongs in the hands of healthcare specialists (56). In non-pregnant patients, hypomagnesaemia can manifest with the highest frequency at the cardiovascular level, but symptoms can also be observed in the nervous and muscular systems (5); we suppose this to be similar in the case of pregnant patients. In obstetrics and gynaecology, magnesium is used as a vasodilator and muscle relaxant, and its effect on the cardiovascular system is used to regulate blood pressure and in addition also to lower the levels of prostaglandins (62). However, a study by Makrides et al. (2014), explains that there is not enough high‐quality evidence for confirmation that dietary magnesium supplementation during pregnancy is beneficial (63). To sum up, maternal hypomagnesaemia can increase the risk for pregnancy complications and, in certain cases, lead to foetal hypomagnesaemia, which can have a far-reaching impact on the future health of the offspring. Conclusion Magnesium has a crucial role in normal cellular and organ functioning and in the metabolic and biochemical pathways of the cells of maternal and foetal organisms. During pregnancy, there is an increased need for magnesium. The maternal serum magnesium values during trimesters may fluctuate slightly, but more significantly so when approaching the third trimester. Maternal hypermagnesaemia during pregnancy is a rather rare medical condition, and maternal hypomagnesaemia can be caused by pregnancy-related or pregnancy-unrelated factors. Lowered maternal magnesium levels or magnesium restriction can lead to foetal complications; however, there is still limited data. If required, magnesium supplementation seems to be safe for maternal and foetal health with appropriately adjusted doses in the form of oral administration. Parenteral magnesium administration belongs in the hands of healthcare specialists and requires careful monitoring. REFERENCES 1. Dalton LM, Ní Fhloinn DM, Gaydadzhieva GT et al. Magnesium in pregnancy. Nutr Rev. 2016;74(9):549-557. 2. Fanni D, Gerosa C, Nurchi VM et al. The Role of Magnesium in Pregnancy and in Fetal Programming of Adult Diseases. Biol Trace Elem Res. 2021;199(10):3647-3657. 3. Morton A. Hypomagnesaemia and pregnancy. Obstet Med. 2018;11(2):67-72. 4. Jouanne M, Oddoux S, Noël A et al. Nutrient Requirements during Pregnancy and Lactation. Nutrients. 2021;13(2):692. 5. Jahnen-Dechent W, Ketteler M. Magnesium basics. Clin Kidney J. 2012;5(Suppl 1):i3-i14. 6. Hidiroglou M, Knipfel JE. Maternal-Fetal Relationships of Copper, Manganese, and Sulfur in Ruminants. A Review. J Dairy Sci. 1981;64(8):1637-1647. 7. 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[online]. 2023 Sept [cited 2023 July 5].Available from: https://www.msdmanuals. Tab. 4. Increased risk for foetal complications caused by lowered maternal magnesium levels or due to magnesium restrictions Anatomical foetal body systems Increased risk for foetal complications by magnesium deficiency exocrine or integumentary systems insufficient data skeletal system insufficient data muscular system insufficient data nervous system anxiety in the offspring in adulthood2 decrease in foetal neuroprotection2, 51 worsened cognitive outcomes2 respiratory system insufficient data gastrointestinal and excretory systems insufficient data endocrine system IUGR2/foetal growth restriction50 problems in foetal development2 increase in body fat2 induced insulin resistance and impaired glucose tolerance2 small for gestational age2/foetal growth retardation9 lower birth weight9 circulatory and cardiovascular systems foetal anaemia52 immune and lymphatic systems insufficient data renal and urinary systems insufficient data reproductive system insufficient data other foetal complications foetal programming theory of diseases later in life2 increased risk for metabolic syndrome later in life2 premature birth1, 2, 9, 49, 53 epigenetic dysregulation2 foetal malformation52 placental dysfunction9 worsened placental development50 worsened foetal growth50 foetal loss50 increased ROS production between maternal-foetal units54 indirect decrease in antioxidant defence54 Note: Insufficient data: more detailed information that could provide a closer explanation is not available. IUGR (intrauterine growth restriction) and SGA (small for gestational age) pathologies may overlap with those of other conditions that can be influenced by nutrition.1
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