Objectives: The use of magnesium sulfate (MgSO₄) in European obstetric units is unknown. We aimed to describe reported policies and actual use of MgSO₄ in women delivering before 32 weeks of gestation by indication. Methods: We used data from the European Perinatal Intensive Care in Europe (EPICE) population-based cohort study of births before 32 weeks of gestation in 19 regions in 11 European countries. Data were collected from April 2011 to September 2012 from medical records and questionnaires. The study population comprised 720 women with severe preeclampsia, eclampsia or HELLP and 3658 without preeclampsia delivering from 24 to 31 weeks of gestation in 119 maternity units with 20 or more very preterm deliveries per year. Results: Among women with severe pre-eclampsia, eclampsia or HELLP, 255 (35.4%) received MgSO₄ before delivery. 41% of units reported use of MgSO₄ whenever possible for pre-eclampsia and administered MgSO₄ more often than units reporting use sometimes. In women without pre-eclampsia, 95 (2.6%) received MgSO₄. 9 units (7.6%) reported using MgSO₄ for fetal neuroprotection whenever possible. In these units, the median rate of MgSO₄ use for deliveries without severe pre-eclampsia, eclampsia and HELLP was 14.3%. Only 1 unit reported using MgSO₄ as a first-line tocolytic. Among women without preeclampsia, MgSO₄ use was not higher in women hospitalised before delivery for preterm labour. Conclusions: Severe pre-eclampsia, eclampsia or HELLP are not treated with MgSO₄ as frequently as evidence-based medicine recommends. MgSO₄ is seldom used for fetal neuroprotection, and is no longer used for tocolysis. To continuously lower morbidity, greater attention to use of MgSO₄ is needed.