pregnancy – Inside Pediatrics

Neonatology

Studying magnesium sulfate in very preterm babies

Research shows magnesium sulfate does not improve neurodevelopmental outcomes in very preterm babies. (Stock photo)

By Anna Jones

Research led by Children’s of Alabama and the University of Alabama at Birmingham (UAB) shows that magnesium sulfate does not improve neurodevelopmental outcomes in babies born very preterm between 22 and 24 weeks gestation.

Babies born during 22-24 weeks of gestation have a higher risk of neurodevelopmental impairment. While prior studies have found that magnesium sulfate helps prevent the development of cerebral palsy for babies born at later gestational ages between 24 and 32 weeks, this observational study led by Margaret Page, M.D., and Ashley Battarbee, M.D., in the UAB Department of Obstetrics and Gynecology, along with colleagues in the Department of Pediatrics, is one of the few studies of its kind to look at the use of magnesium sulfate for babies born at 22-24 weeks of gestation.

“This multicenter study led by Dr. Page and colleagues at UAB is important as it is the largest study designed to assess the two-year outcomes of infants born extremely preterm exposed to antenatal magnesium sulfate and/or steroids, two common treatments given before delivery,” said Wally Carlo, M.D., co-director of Neonatology at UAB and Children’s of Alabama and the Neonatal Research Network.

Battarbee says that OBGYNs cannot always stop a preterm birth, so they oftentimes need to shift their focus to how they can best prepare the baby to be born early.

“We consider interventions such as administering magnesium sulfate or antenatal corticosteroids to the pregnant patient to help improve outcomes for their baby after birth,” Battarbee said. “While the American College of Obstetricians and Gynecologists (ACOG) recently updated their guidance on corticosteroids for babies at 22 weeks, we did not have updated guidance on magnesium sulfate and wanted to explore this treatment further.”

The results of the recent study reinforce current national guidelines recommended by ACOG and the Society of Maternal-Fetal Medicine that do not recommend giving magnesium sulfate at 22 weeks and instead prioritizing antenatal corticosteroids to improve neurodevelopmental outcomes. Unlike magnesium, steroids have demonstrated benefit for infants born at very early gestational ages and remain the primary intervention when an early delivery is anticipated.

“There is not a lot of guidance on the use of magnesium sulfate in babies at this gestational age,” said Page, the lead investigator of the study. “Through this research, we were able to find that there was no benefit to using magnesium sulfate in addition to antenatal corticosteroids. This shows us that more treatment does not always equal better outcomes.”

Both Page and Battarbee emphasize that administering magnesium sulfate at that gestational age did not lead to any measurable increase in maternal or fetal harm in this study, but magnesium does carry known maternal risks, making it important not to use it without proven benefit. Additionally, using magnesium for neuroprotection in babies at these very early gestational ages when it is not effective may hinder future research in identifying interventions that truly make a difference.

This analysis was conducted using data from and in collaboration with the Neonatal Research Network, a large research network encompassing academic institutions across the United States funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

July 22, 2026 by childrensal

Endocrinology

Long-Term Effects of Gestational Diabetes on Kids

A new study from Children’s of Alabama shows the lasting impact of gestational diabetes on the child. (Stock photo)

New findings from a follow-up study at Children’s of Alabama and the University of Alabama at Birmingham (UAB) shed light on how a mother’s health during pregnancy may influence her child’s body weight well into adolescence—especially if that pregnancy was complicated by gestational diabetes. Led by pediatric endocrinology fellow Mary Margaret Barr, M.D., the new analysis builds on the foundational HAPi (Health After Pregnancy) study, conducted by Paula Chandler-Laney, Ph.D., who directs UAB’s Ph.D. program in nutrition.

That original study assessed the health of 219 children ages 4 to 10. Mothers were divided into three groups based on her health during pregnancy: normal weight mothers without gestational diabetes (group 1); overweight or obese mothers without gestational diabetes (group 2); and overweight or obese mothers with gestational diabetes (group 3). Health-related data collected on the children included body mass index (BMI), waist-to-hip ratios, blood pressure and metabolic markers like glucose and cholesterol levels.

Barr’s research, which she presented at the Pediatric Endocrine Society annual meeting in May, went a step further. She reviewed electronic health records of 139 of the original study group to see how each group’s BMI Z-score—a metric that adjusts BMI for a child’s age and sex—changed as they entered adolescence.

As anticipated, children in group 3 (whose mothers had gestational diabetes and obesity) started off with higher BMI Z-scores that continued to trend upward through adolescence. “These were kids exposed to higher sugars while they were growing inside mom,” Barr said. Another key finding: Of all the children who had normal BMI Z-scores at the time of the original HAPi study (ages 4-10), those exposed to gestational diabetes (group 3) were significantly more likely to become overweight in adolescence.

Group 1—the control group—maintained healthy BMI levels over time, with only a slight rise in average BMI Z-score, which is often seen at adolescence.

The surprise came with group 2. These children, born to mothers with overweight or obesity but no gestational diabetes, initially had higher BMI Z-scores—even higher than group 3 at the study’s start. But over time, most of these children saw improvements in their BMI. “They started off big and then they got better,” Barr said. “Eventually, they ended up in the same range as the children born to normal weight mothers.”

This unexpected trend persisted even after adjusting for factors like maternal BMI, maternal education, household income and the number of children in the home. “These moms were of lower income, most of them below the poverty line, and had a lower education status,” she said. “You would have expected them to parallel group 3 and get worse over time. But they didn’t.”

The reason for the disconnect isn’t clear. “Nothing else stood out except for the child’s BMI during the HAPi study,” she said. “If you were heavier during the HAPi study, you were more likely to wind up heavier in adolescence. But it wasn’t a super strong correlation.”

Although none of the children developed diabetes during the follow-up period, Barr found a handful of prediabetes cases in groups 2 and 3.

The research provides a clue for pediatricians to intervene early in children with a high risk of obesity and/or diabetes. If the pediatrician knows the mother’s pregnancy weight and gestational diabetes history, they can be aware that the child may have a higher risk for obesity in the future. “So it’s probably more important to start earlier with healthy habits, a varied diet with less fried food, more vegetables, reasonable expectations of portion sizes, and exercise and movement,” Barr said.

While gestational diabetes and maternal obesity both increase a child’s risk for obesity, Barr’s findings suggest that gestational diabetes carries a more lasting impact than exposure to obesity alone. “We don’t fully understand the relationship between genetics, environment and exposures” on childhood obesity, she said. “But this data gives us another piece of the puzzle.” Her next step after publication is to expand the dataset to include maternal weight and metabolic health since the original study ended.

July 28, 2025 by childrensal