Bed Rest May Not Be Best For High Risk Pregnancies

Women with high risk pregnancies are usually ordered by their doctors to stay in bed and off their feet.  Bed rest means no working and the restriction of the pregnant woman’s activities.  Doctors order this in an attempt to prevent pregnancy complications.

Bed rest has been ordered for many types of medical illnesses going back to the time of Hippocrates.  However, in the 19th century people began to question whether there were any proven benefits to bed rest and if there were any negative consequences.  There has been a growing wealth of information regarding the adverse physical effects of prolonged bed rest.  These adverse effects include muscle wasting and weakening, bone loss, heart deconditioning, blood clots, and a decrease in immune system functioning.  Even though this information has led to changes in the recommendation that bed rest be used for many medical conditions, including pregnancy, bed rest still remains a commonly prescribed treatment in the improvement of pregnancy outcomes in pregnancies with complications (despite the lack of any proven benefit to either the mother or the fetus).  Bed rest also has a negative emotional and social impact on the patient as well as her family.  There is also a profound negative financial effect in terms of lost work hours.

However, obstetricians still continue to recommend bed rest for a variety of reasons.  Sometimes they fear being held responsible for an adverse outcome if bed rest is not recommended.  Besides, bed rest appears to be innocuous, inexpensive, and makes perfect simple sense; and with the lack of evidence that had previously held sway over centuries of clinical practice, there has been little reason to change the practice.

The June 2013 edition of the Journal of Obstetrics and Gynecology presented a study that examined the frequency of recommendations for bed rest in women who had high risk pregnancies because of a shortened cervix.  After the variables were controlled for, the group of patients who were recommended bed rest were almost 2.5 times more likely to give birth preterm before 34 weeks.  Therefore, these findings indicate that bed rest did not have any benefit but it may have actually been harmful.  Another article summarized the data from multiple reviews on using bed rest to treat various pregnancy complications and it also did not find any sufficient evidence to support its use.  In fact it did find an increase in physical, psychological, and financial harm in its use, therefore concluding that it would be unethical to continue to prescribe bed rest for pregnancies.

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