Correspondence (letter to the editor): Primary Prevention of Premature Labor Was Given Short Shrift

The two most common causes of premature labor are fetoplacental supply disruptions and ascending vaginal infections.

Systematic histological analysis of the placenta in premature babies shows disruptions to maturation and differentiation, as well as discordances and vascular pathologies (associated with reduced endothelial NO production?). Possible causes include suboptimal nutrition of the pregnant woman, which can disrupt placentation and development—for example, subsequent to deficiencies in magnesium, vitamins, and long-chain fatty acids. Magnesium substitution, given as early as possible and continuously throughout the pregnancy, prevents premature labor, neonatal underweight, premature rupture of the amniotic membrane (2), and pre-eclampsia (3, 4): a global indication of the fact that magnesium improves the function of the fetoplacental unit. It is therefore not surprising that for the treatment of premature labor (1), similar substances have been found to be effective as for pre-eclampsia (MgSO₄ or nifedipine).

Pathogens from the vagina are (owing to prostaglandin mechanism) a cause for premature cervical maturation (dilation of the internal os to 1 cm, cervical length less than 1 cm, and presence of painful uterine contractions), premature labor, or premature membrane rupture. For the purposes of secondary prevention, measuring the pH in the vagina by using the Saling procedure is useful, as is the often-neglected microscopic examination of a vaginal swab. For the purposes of primary prevention, nutritional status (vitamins) and sufficient magnesium supplementation for the pregnant women are important (2), as has become evident from a reduction in premature membrane rupture (2). Magnesium catalyzes more than 300 enzymatic reactions and contributes to optimizing pregnant women's immune systems, which is useful in combating pathogens in the vagina.

Long years of the author's own experience, and his own views (further reading at www.magnesium-ges.de) have shown that magnesium supplementation is beneficial for developments in pregnancy and should be given early and continuously. If this has not been done then higher doses of oral magnesium can help save the pregnancy even at the onset of initial symptoms. However, magnesium should not be given simultaneously as oral calcium (which some “prenatals” contain—for example, those of US origin).