Can magnesium gluconate be used as an alternative therapy for preeclampsia?

Magnesium (Mg+2) in the body plays a structural and regulatory role and it is involved in fundamental cellular reactions. It is known that Mg+2 blood levels decrease during pregnancy, which has been related to preeclampsia and premature delivery, as well as other pathologies such as cardiovascular alterations and renal, gastrointestinal, neurological, and muscular dysfunctions among others. Mg+2 salts are used to treat its deficiency, and parenteral magnesium sulfate (MgSO4) is relatively effective in preeclampsia and eclampsia. The use of MgSO4 has the main disadvantage that it is mainly administered intravenously which leads to significant toxicity risks. Currently, other magnesium salts are being studied as alternative treatments. Magnesium gluconate (Mg-gluconate) has been used to prevent pregnancy-induced hypertension, showing a greater antioxidant capacity than MgSO4. Mg-gluconate can scavenge hydroxyl and alkoxyl radicals and it has been shown that it can inhibit lipid peroxidation in microsomal membranes treated in vitro with the Fenton reaction. Mg-gluconate seems to be an excellent candidate to replace MgSO4 as a therapy for preeclampsia with severe features.El magnesio (Mg+2) en el organismo, juega un papel estructural y regulador, y participa en reacciones celulares fundamentales. Se sabe que los niveles séricos de Mg+2 disminuyen durante el embarazo, lo cual se ha relacionado con la preeclampsia y el parto prematuro, así como con otras patologías como alteraciones cardiovasculares y disfunciones renales, gastrointestinales, neurológicas, musculares, entre otras. Las sales de Mg+2 se utilizan para tratar su deficiencia, y el sulfato de magnesio parenteral (MgSO4) ha demostrado ser relativamente eficaz en la preeclampsia y la eclampsia. El uso de MgSO4 tiene el principal inconveniente de que se administra principalmente por vía intravenosa, lo cual conlleva a riesgos importantes de toxicidad. Actualmente, se están estudiando otras sales de magnesio como tratamientos alternativos. El gluconato de magnesio (Mg-gluconato) se ha utilizado para prevenir la hipertensión inducida por el embarazo, mostrando una mayor capacidad antioxidante que el MgSO4. El Mg-gluconato es capaz de eliminar radicales hidroxilo y alcoxilo e inhibir la peroxidación lipídica en membranas microsomales tratadas in vitro con la reacción de Fenton. El Mg-gluconato parece ser un excelente candidato para sustituir al MgSO4 como terapia para la preeclampsia con características graves.Sociedad Argentina de Fisiologí

Magnesium salts in pregnancy

Background: Magnesium is one of the most abundant elements in the body. Although the total serum magnesium content does not represent more than 1% of total body magnesium, serum magnesium determinations have been routinely used in clinical practice to assess body magnesium status. Thus, serum magnesium concentration ranges from 1.8 to 2.2 mg.dl−1 (0.75–0.95 mmol.l − 1 or 1.5–1.9 mEq.l − 1). Consequently, when serum magnesium levels fall below the range considered normal, the patient is diagnosed with hypomagnesemia. This deficiency has been associated with low-grade systemic inflammation, increased levels of proinflammatory molecules, mitochondrial dysfunction, increased reactive oxygen species production, and hypertriglyceridemia leading to an increase in the number of easily oxidizable lipoproteins in the circulation. Results: Several magnesium salts have been used to treat hypomagnesemia during pregnancy, with magnesium sulfate (MgSO4) being the most commonly used magnesium salt in current obstetric practice. However, the exact mechanism of action of MgSO4 remains largely an enigma, and its parenteral use poses a significant toxicological risk at high doses. In this review, we summarize the use of magnesium salts during pregnancy not only from a clinical point of view but also, with the use of computational simulations, discuss advances in the understanding of the molecular mechanisms of action of magnesium salts, with emphasis on MgSO4. These molecular simulations are required to unveil the pharmacological action of the magnesium salts during pregnancy. Conclusions: MgSO4 plays a role as an antioxidant agent at the plasma membrane level which can explain the mechanism of action of this salt in current obstetric practice