ANDALAS OBSTETRICS AND GYNECOLOGY JOURNAL

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SYSTEMATIC REVIEW
THE ROLE OF MAGNESIUM SUPPLEMENTS ON HYPERTENSION IN
PREGNANCY AND PREECLAMPSIA
Raissa Nurwany1, Shafira Fitri Ramadhina2, Pariyana3
1. Department of Obstetrics and Gynecology, Faculty of Medicine, Sriwijaya University, Palembang,
South Sumatra; 2. Medical Professional Study Program, Faculty of Medicine, Sriwijaya University,
Palembang, South Sumatra; 3. Department of Public Health Sciences, Faculty of Medicine, Sriwijaya
University, Palembang, South Sumatra

Correspondence: Raissa Nurwany;Raissa.nurwany@fk.unsri.ac.id ; 081271308880

Abstract
Objective:This article aims to discusses the effects of magnesium supplementation on clinical
outcomes of pregnancy and highlights the benefits of magnesium supplementation in reducing the
risk of hypertension in pregnancy and preeclampsia.Method:In this systematic review article, the
author conducted a literature search using certain keywords and selected articles that were
published from 2013-2023, can be accessed in full-text in pdf format, and are in Indonesian or
English. The methods used were in accordance with the reporting guidelines provided in the
Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols
(PRISMA-P).Results:After carefully searching the database and eliminating articles that were not
related to the topic, 6 articles were obtained for review. Hypertension in pregnancy and
preeclampsia are serious health problems that can harm both mother and baby. Magnesium
supplements have been studied as a way to reduce the risk of hypertension in pregnancy and
preeclampsia.Conclusion:Magnesium supplements may help reduce the risk of hypertension in
pregnancy and preeclampsia.

keywords: Preeclampsia; Magnesium supplements; Pregnancy

Abstract
Objective: In this article, the author discusses the effect of magnesium supplementation on
clinical outcomes of pregnancy and highlights the benefits of magnesium supplements in reducing
the risk of hypertension during pregnancy and preeclampsia. Method: In this systematic review
article, the author conducted literature searches using specific keywords and selected articles
published from 2013-2023, which can be accessed in full-text in pdf format, and are in Indonesian or
English. The method used is in accordance with the reporting guidelines provided in the Preferred
Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Result: After
conducting a thorough search in the databases and eliminating articles unrelated to the topic, 6
articles were reviewed. Hypertension during pregnancy and preeclampsia is a serious health problem
that can endanger both the mother and the baby. Magnesium supplements have been studied as one
way to reduce the risk of hypertension during pregnancy and preeclampsia. Conclusion: Magnesium

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supplements can help reduce the risk of hypertension during pregnancy and preeclampsia.
Keywords: Preeklampsia; Magnesium supplementation; Pregnancy

INTRODUCTION

Hypertension in pregnancy is a major problem in the health of pregnant women because it

has high mortality and morbidity rates.1 According toWorld Health Organization (WHO), the
incidence of preeclampsia ranges from 2% to 10% of all pregnancies in the world with 1.8% -
16.7% of the incidence reported in developing countries.2 In Indonesia, preeclampsia is the
second leading cause of death among pregnant women with an incidence of around 24% of
total pregnancies.3
Hypertension in pregnancy is defined byInternational Society for the Study of Hypertension
in Pregnancy (ISSHP) as systolic blood pressure ≥140 mmHg or diastolic ≥90 mmHg at a
gestational age of more than 20 weeks.4 Hypertension in pregnancy and preeclampsia have
an impact on maternal and fetal health in the short and long term. Preeclampsia can
increase the risk of occurrence long-term hypertension, cardiovascular disease mortality, and
maternal stroke. Preeclampsia can also increase the risk of occurrenceIntra-uterine growth
restriction (IUGR), preterm birth, oligohydramnios, placental abruption, fetal distress, and
fetal death.4
The cause of preeclampsia is still uncertain, but the most widely believed theory is that
there is an abnormality in the placental implantation process which disrupts the process of
remodeling the spiral arteries, resulting in placental hypoxia.5 The difference in incidence in
developing and developed countries shows the role of environmental factors in the
occurrence of preeclampsia. Another theory related to gene variations and nutritional
factors is the administration of vitamins C and E, L-Arginine, calcium and magnesium as
non-pharmacological interventions in preeclampsia.6
Magnesium (Mg) has an important role in regulating vasomotor tone and cardiac excitability.
Magnesium intake for women is recommended to be 280 mg/day, while magnesium intake
during pregnancy is 350 mg/day. This amount is needed to maintain the function of more
than 300 enzymes that use ATP.7 The most common causes of magnesium deficiency are
insufficient intake or impaired absorption, increased excretion, or increased magnesium
requirements such as during pregnancy. Magnesium deficiency during pregnancy is
associated with an increased risk of preeclampsia.8
There are several studies that explain that magnesium supplementation during pregnancy
can prevent pregnancy complications. However, the limited literature regarding the role of
magnesium supplementation in hypertension during pregnancy and preeclampsia makes the
author want to write this literature review article.

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METHOD

The literature sources used come from national and international journal websites such as
Google Scholar, Science Direct, Elsevier, PubMed, and StatPearls. Search using
keywords:Preeclampsia, Magnesium supplementation, hypertension in pregnancy, Oral
magnesium, Pregnancy outcome, Prevention (AND, OR). The selection criteria for literature
selection use literature published from 2013-2023, which can be accessed online full-text in
pdf format, and in Indonesian or English. The methods used in this systematic review are
reported in accordance with the reporting guidelines provided inPreferred Reporting Items
for Systematic Review and Meta-Analysis Protocols (PRISMA-P).

RESULTS AND DISCUSSION

OnFigure 1,After carefully searching the database and eliminating articles that were not
related to the topic, 6 articles were obtained for review, namely: 2 original article regarding
the effects of magnesium supplementation on clinical outcomes of pregnancy, 1 original
article regarding magnesium supplementation and blood pressure in pregnancy, 2 original
article regarding the effects of magnesium supplementation and preeclampsia, and 1
systematic review of magnesium supplementation in pregnancy.

The role of magnesium in pregnancy

Magnesium is one of the essential minerals needed during pregnancy.
Magnesium is useful for maintaining the function of various enzymes and acts as a cofactor
in more than 600 enzyme reactions.14 Magnesium plays a role in energy metabolism, nucleic
acid and protein synthesis, bone formation, and neuromuscular signaling.15 Magnesium
levels have a significant effect on cardiac excitability, contractility, and reactivity. Magnesium
also causes relaxation of vascular muscles. During pregnancy, physiologically magnesium
levels will decrease. Decreased magnesium levels in pregnancy are still not well understood.
Serum magnesium decreases during pregnancy due to hemodilution, which is a natural
process that occurs during pregnancy, where the body produces more blood to support fetal
growth.16 In addition, maternal hypomagnesemia is associated with a decreased renal
clearance and increased mineral consumption by the fetus.17
Several studies show that low magnesium levels are associated with preeclampsia, as
well as being associated with preterm birth, gestational diabetes, restricted fetal growth, or
low birth weight.8,13 Hypomagnesemia during pregnancy can interfere with fetal growth and

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development and can cause premature labor. Preterm labor is caused by uterine
hyperexcitability caused by chronic hypomagnesemia in the mother and further aggravated
by stressful situations in the mother. Magnesium deficiency during the gestational period
can have major impacts on the mother, fetus and child that may last throughout life. The
consequences of primary magnesium deficiency in the mother are not limited to the
prenatal and perinatal periods. Low magnesium levels during pregnancy may have important
consequences throughout life, with hypomagnesemia representing an important factor in
the broad spectrum of fetal programming theories regarding diseases that emerge later in
life, in childhood, or in adulthood.18

Magnesium and hypertension in pregnancy

Magnesium supplementation is a therapeutic option for preventing eclampsia
and its use is preferred over phenytoin and diazepam. Magnesium was associated with a
59% reduction in the risk of eclampsia and a 36% reduction in abruption. Magnesium is
recommended in women with severe preeclampsia.19 Magnesium plays a role in inhibiting
calcium channels thereby preventing an increase in intracellular calcium concentration
which causes vasodilation. In addition to improving blood flow, the vasodilatory effects of
magnesium have been shown to prevent preeclampsia by selectively dilating cerebral blood
vessels and eliminating cerebral spasms associated with preeclampsia.20 Atiba et al, in their
study there were 27 of 28 patients with severe systolic hypertension (≥160 mmHg) had low
magnesium levels (<0.63 mmol/l), while 9 patients with mild systolic hypertension (140-159
mmHg) had low magnesium levels, but this was not statistically significant (P>0.05).13
Several studies show that the risk of hypertension in pregnancy is related to changes
in magnesium homeostasis. Meta-analysis studyCochrane shows that the efficiency of
magnesium supplementation has not been proven in preventing hypertension in pregnancy,
but there are several studies that suggest magnesium supplementation.12
Research by Ika Yulia et al found the benefits of magnesium supplementation in
preventing preeclampsia in pregnant women with hypomagnesemia so that the incidence of
hypomagnesemia in women can be used to predict preeclampsia.9 Rylander et al in their
review of magnesium and blood pressure in pregnancy, showed the influence of magnesium
supplementation on blood pressure regulation during pregnancy. Magnesium plays a role in
the pathophysiology of pre-eclampsia and magnesium sulfate supplementation is
recommended for the treatment of pre-eclampsia. Magnesium sulfate has been shown to
have vasodilatory effects through inhibition of angiotensin II and endothelin I and may also
have an immunomodulatory role.16
Therefore, magnesium supplementation is beneficial in pregnant women with
hypomagnesemia. The recommended magnesium intake during pregnancy is 350 mg/day.
Based on the Regulation of the Minister of Health of the Republic of Indonesia No. 75 of
2013 concerning the recommended nutritional adequacy rate (RDA) for pregnant women,
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the recommendation for magnesium intake is +40 mg in the 1st, 2nd and 3rd trimesters with
the RDA for women of reproductive age being 310–320 mg.
In a clinical study conducted by Maria B et al, as many as 199 pregnant women met
the inclusion criteria, then the magnesium supplementation and placebo interventions were
administered randomly. As a result, 25% of mothers who were given magnesium
supplementation experienced an increase in diastolic blood pressure <15 mmHg compared
to the placebo group (P value <0.05). However, the number of mothers diagnosed with
hypertension in pregnancy and preeclampsia was evenly distributed between the groups
with magnesium supplementation and placebo.10 In addition, an experimental study by Ika
et al in Padang, Indonesia, of 90 mothers divided into intervention groups with
hypomagnesemia, normal magnesium, and a control group with normal magnesium, found
that magnesium supplementation was associated with preeclampsia in pregnant women
with hypomagnesemia (RR = 6.51 [95% CI 1.06 – 39.93]). Thus, it is reasonable to assume
that magnesium insufficiency is a frequent maternal risk of preeclampsia.9 In a clinical study
conducted by Elaheh Z et al in Iran, using the same method without hypomagnesemia,
magnesium had a beneficial effect in the group given oral supplementation. This was proven
to reduce the rate of preeclampsia (P = 0.018) and this research is in line with research by
Bullarbo et al, that magnesium supplementation can prevent an increase in diastolic blood
pressure during the final week of pregnancy.8 Several studies studying the role of
magnesium supplements in preeclampsia and hypertension in pregnancy have been
concluded inTable 1.
According to Shaykh et al, magnesium plays an important role in blood pressure
control. Consumption of fruits and vegetables rich in potassium and magnesium is
associated with lower blood pressure during pregnancy. This is because magnesium plays an
important role during pregnancy, and 33% of patients with low magnesium levels are likely
to develop preeclampsia.9 Magnesium deficiency during pregnancy is associated with
hypertension and preeclampsia.21 Magnesium is an important element to prevent various
diseases during pregnancy and unwanted complications. Moreover, magnesium has various
physiological benefits. Many studies have been conducted to assess the effects of
magnesium supplementation on preventing preeclampsia and hypertension in
pregnancy.8,22,23
Hypermagnesemia usually occurs in preeclamptic women after magnesium
supplementation therapy.16 Hypermagnesemia can have a negative impact on the mother
and indirectly harm the fetus. Several studies have shown that the fatal oral dose of
magnesium for humans ranges from 0.5 to 5 g/kg in adults. Symptoms can vary from mild to
severe depending on age, gender, health condition and various internal and external
factors.24 Toxicity studies on a single dose of magnesium sulfate with intravenous
administration carried out on rats and dogs showed that the LD50 value was 206 mg/kg for
males and 174 mg/kg for females.25
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CONCLUSION

Magnesium supplementation has been proven to prevent the incidence of

hypertension in pregnancy and preeclampsia, especially in mothers with hypomagnesemia.
In addition, magnesium insufficiency has been proven to be associated with the incidence
of preeclampsia. Although magnesium supplementation may not be necessary for pregnant
women with their first pregnancy who do not have risk factors for hypertension in
pregnancy or preeclampsia because magnesium is found in many food sources, magnesium
absorption can be influenced by many factors, even though magnesium needs in pregnant
women tend to increase. With the many physiological effects obtained from magnesium
supplementation, there is no harm in pregnant women taking oral magnesium
supplementation.
Copy and paste tWrite down the source of funds (grants) or other financial support along
with the grant number and URL of the funder's website (if any).
The author would like to thank those who have helped write this scientific work.
The writing of this systematic review article has no conflict of interest.

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