Alternatives to mag - or things to try beforehand?

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ilovepie
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Re : Alternatives to mag - or things to try beforehand?

Postby ilovepie » Sun Apr 25, 638923 6:52 pm

You know, silly as it sounds, it literally had not even occurred to me to talk to my nephrologist about it. I will talk to him about it at my next appointment. I also plan to talk to my OB next week about my concerns - he's not an MFM, but we're consulting with the MFM from my first pregnancy.

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caryn
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Re : Alternatives to mag - or things to try beforehand?

Postby caryn » Sun Apr 25, 638923 1:51 am

Yeah, as Catherine says, the data just really don't support using other anti-convulsants, because the mechanism triggering PE seizures is apparently entirely different -- when you look at the mechanical/biochemical pathways -- from other seizures.

Have you got an MFM consulting with a nephrologist? I'm thinking this is really a question for a nephro, because your underlying kidney issues present a big hurdle to the only known treatment. If it's hard for your kidneys to clear it out, you might end up needing a much lower/ more tightly monitored dose to get the same effect, since it wouldn't be being metabolized or excreted at the normal rate. (Lots and lots of hospital blooddraws, oh yay.)

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catherine
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Re : Alternatives to mag - or things to try beforehand?

Postby catherine » Tue Apr 13, 638923 3:00 pm

The use of MgSO4 is primarily as prophylaxis against seizures due to eclampsia. The Magpie trial (huge, multi-centered) indicated that this is the most effective agent, protecting against morbidity better than diazepam, phenytoin, chlormethiazole and barbituates.

Whether or not it can assist in controlling BP, its use is pretty much standard-of-care because the risks to both mother and baby during an eclamptic seizure is so high.

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l412angel
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Re : Alternatives to mag - or things to try beforehand?

Postby l412angel » Tue Apr 13, 638923 10:10 am

Interesting! Dont worry I think a ton of us here are "nerotic pain's in the butt" :)

ilovepie
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Re : Alternatives to mag - or things to try beforehand?

Postby ilovepie » Tue Apr 13, 638923 6:54 am

My first pregnancy was really confusing. haha

I was assumed to be chronic hypertensive, secondary to the kidney disease. But I had never actually had hypertension - because I'd been medicated with therapeutic doses of ACEs and/or ARBs for all the previous decade! So, they took me off all medications at the beginning of my pregnancy and I never was diagnosed with PIH or really referred to as chronic hypertensive. My blood pressures started to rise around 27 weeks and then became labile at 30 weeks. They would be gorgeously normal laying on my side and shoot up frighteningly high if I so much as sat up.

It still wasn't referred to as PIH - just labile blood pressure and, according to my nephrologist, "what kidney disease does in pregnancy."

After my pregnancy I was left off of medications (after a brief period getting them back to normal immediately postpartum) until I was clearly hypertensive at about 8-9 months postpartum. So now I am officially and clearly a chronic hypertensive.

I was followed solely by an MFM during my first pregnancy, and we will be consulting with him again (though we're seeing a "regular" Ob this time for regular appointments). I have a whole list of specialists to contact, and I have found some studies whose authors I might bother :). I always feel like a lot of the data doesn't *quite* apply to me, so I try to seek out as much information as possible!

I'm a total neurotic pain in the butt :-)

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Re : Alternatives to mag - or things to try beforehand?

Postby aggie95mom » Tue Apr 13, 638923 6:36 am

No help on this one, but I'll be curious to see any responses. Mag did nothing for my blood pressure either both times I was on it.

I'm curious, though, about you saying you were diagnosed with PE after Labetalol didn't bring down your pressures. Were you on an increased dosage? Did they try other meds? From what I've seen around here, some women respond to Labetalol and others don't. My OB (and I don't know/haven't researched any study associated to this) says his experience is that women who only developed high BP inside of pregnancy tend to respond better to Labetalol than those with chronic hypertension.

Do you see an MFM? Maybe they have more information for you?

ilovepie
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Alternatives to mag - or things to try beforehand?

Postby ilovepie » Fri Apr 02, 638923 8:34 pm

I'm pregnant with my second baby, and exploring options for the second birth.

Labetalol was administered with my first, and when my blood pressure did not come down I was diagnosed with preeclampsia (blood pressure was the sole criteria for diagnosis with me because I spill 5-6g of protein when not pregnant).

I am aware of a study underway in Utah that is exploring whether Labetalol is similarly effective to magnesium sulfate in preventing eclamptic seizures - regardless of effect of blood pressure.

I doubt the findings of this study will have been published by the time this second baby is delivered, but wondered if there was any more information on this? My blood pressure didn't come down on magnesium either, though of course I understand its anti-convulsive efficacy has nothing to do with necessarily lowering blood pressure.

I've also read that diazepam, phenytoin, chlormethiazole and barbituates are used in place of magnesium in countries outside the U.S. - I wondered why they are not used in the U.S. (I figured it was an off-label use issue, a lack of research/data issue, or something else entirely that I'm not aware of?)

I am *not* really thinking of foregoing magnesium should it be recommended, but I have underlying kidney disease and had to be taken off the magnesium before it was really desirable anyway - my kidneys were not clearing it out as well as would be hoped. So I guess I'm just exploring options at this point?



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