Despite side effects, bed rest still common for high-risk pregnancy

Obstetricians regularly prescribe bed rest for women with complicated pregnancies, but many appear to be unaware of the harmful side effects of the inactivity, according to a study by researchers at the UW–Madison School of Nursing.

Published in the current issue of the Journal of Women’s Health, the study also showed that obstetricians vary greatly in the degree of restriction ordered for the same problem, from modest limitation of activity to complete bed rest with no bathroom privileges, as well as the location of bed rest–hospital or home.

“Physicians should know about this tremendous variability, as should the women whose lives and health can be so dramatically affected by bed rest,” said associate professor Judith A. Maloni, who directs a $1.7 million research program investigating bed rest in pregnancy. She expects her research will yield strategies to prevent and treat the adverse side effects, and guide post-partum rehabilitation.

Maloni first documented the deleterious effects of extended bed rest during pregnancy in a 1993 study. She noted psychological repercussions, such as depression, anxiety and boredom; and physical effects, such as headache, muscle atrophy and weight loss, which is undesirable during pregnancy.

Maloni has also observed striking effects in the women well after they delivered their babies, including continuing depression, difficulty walking up and down stairs, deep soreness in back and leg muscles, and slowness in resuming normal activities of daily living.

In her first studies, Maloni took a cue from aerospace researchers, who used bed rest as a model for understanding the weightlessness astronauts experience in space. They found that the consequences of extended bed rest were widespread, severe and quick to appear.

“Physicians soon applied this knowledge to surgical, cardiac and geriatric patients, urging them all to ‘get out of bed to prevent those bad side effects,'” she said. “But bed rest remains a top treatment for women with complicated pregnancies.”

Nearly 700,000 women with problematic pregnancies are sent to bed each year. Prescribed most often for conditions such as preterm labor, pregnancy-related hypertension, slow fetal growth, twin pregnancies, placenta previa and incompetent cervix, bed rest is thought to improve blood flow to the uterus and reduce physical forces that might stimulate dilation.

In the current study, Maloni and her co-investigators surveyed 44 directors of maternal/fetal medicine, academic specialists who generally treat only women with high-risk pregnancies, and 47 general obstetricians with mixed practices. The surveys contained questions about home and hospital bed rest, and whether or not side effects were observed. Physicians were also asked to indicate type and degree of activity restriction they would prescribe for 16 different scenarios.

Data analysis revealed that a broad spectrum of between 89 percent and 93 percent of obstetricians surveyed prescribes from four to 20 weeks of bed rest for complicated pregnancies. Most were unaware of any significant physical or psychological side effects of the treatment.

“This is troubling because post-partum women are being discharged in a deconditioned state without receiving any recommendations on symptoms they can expect during their recovery and how they can get help,” said Maloni, who organizes support groups of pregnant women relegated to bed in local hospitals.

The study also showed great variability between and within physician groups.

For women carrying twins, for example, 2.3 percent of the specialists prescribed no restriction, seven percent prescribed limited activity at home, more than 32 percent prescribed home bed rest with bathroom privileges, and 2.3 percent prescribed strict home bed rest without bathroom privileges. More than four percent prescribed limited bed rest at the hospital, 46 percent prescribed bed rest with bathroom privileges at the hospital and nearly five percent prescribed stricter bed rest at the hospital.

Among the general obstetricians, 19 percent prescribed some degree of limited activity at home for twin pregnancies, 27 percent prescribed privileged bed rest at home, and more than six percent prescribed strict bed rest with no privileges. Nearly 32 percent of the obstetricians called for hospital bed rest with bathroom privileges and some 15 percent prescribed strict hospital bed rest.

“The treatment variability for this obstetric complications and the others we studied tells us there appears to be no standard protocol for prescribing bed rest in pregnancy,” Maloni said. “The decision seems to be based solely on individual physician practice style.”

Maloni suggests that the moment women learn they may have complicated pregnancies, they seek second opinions, especially from specialists. Women should also ask obstetricians how they treat high-risk pregnancies and if they are aware of any negative side effects of bed rest.

“It may be possible to find a provider who will help them avoid the extensive side effects associated with bed rest treatment,” she said.