Antepartum Bed Rest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth

Abstract

Preterm birth is the major maternal-child health issue across developed nations and the leading cause of perinatal mortality and morbidity. Of all deaths of infants <1 year of age in the United States in 2005, 68.6% occurred in infants born prior to term. Although the preterm birth rate in European countries is 5-7%, the U.S. preterm birth rate is 12.7%, representing an increase of 9% since 2000. Antepartum bed rest/activity restriction (ABR/AR) has been a mainstay of treatment to prevent preterm birth for the past 30 years prescribed for nearly 1 million women in the United States annually, despite a lack of evidence for its effectiveness. In fact, there is increasing evidence that ABR causes several adverse physiologic and psychological side effects among women and their infants. Unfortunately, these findings have had little impact on clinical practice. This integrative review of literature provides a comprehensive analysis of the evidence for the practice of prescribing ABR and its physiologic, behavioral, and experiential side effects. It also presents a model to guide continuing research about the effects of maternal bed rest as well as evidence supporting the use of home care with bed rest, a different, safe, and feasible model of prenatal care for treating women with pregnancy complications used particularly in other countries. Finally, suggestions to improve the health of high-risk pregnant and postpartum women and their infants are provided.

The support needs of high-risk antenatal patients in prolonged hospitalisation

“…Complications such as preeclampsia and premature labour may limit a woman from reaching term pregnancy and place her in a 'high-risk' category. Bed rest is a very common obstetrical management to restrict maternal activity even though there is minimal evidence that it decreases the risk of preterm delivery (Maloni, 2010). In addition Bigelow and Stone (2011) reviewed existing studies and found that there are no complications of pregnancy for which bed rest is consistently shown to be a beneficial intervention.…”

Feasibility of incorporating a bed-rest exercise program during a twin pregnancy: Case reports

“…Limited research evidence would suggest that pregnant women are also affected by the physiological effects of activity restriction. Important antepartum side effects range from loss of muscle strength and muscle atrophy, weight loss, dizziness, headaches and indigestion to possible lifethreatening thromboembolic events [10][11][12][13][14][15]. Bed rest may therefore be responsible for complicating the antepartum period, regardless of the disease process for which bed rest was originally prescribed.…”

The Effect of the Care Provided Based on Self-Care Model of Orem on Self-Care Agency and Frequency of Nursing Diagnoses in Pregnant Women with Threat of Preterm Birth

“…Maternal stress is high during hospitalization, with the primary sources of stress as separation from and concerns for the family at home, negative emotions, self-image, and health status. [7][8][9] Bed rest may increase costs for the families, directly because of the expenses for the care of other children, or indirectly through job absenteeism. Lastly, it may also increase healthcare costs.…”

“…1 In fact, there are increasing evidences that bed rest causes several adverse physiological and psychological side effects in women and their infants. 7 Some of these physiological and psychological side effects experienced in the antenatal period due to bed rest may develop when the individual cannot meet her own self-care needs sufficiently. When self-care is effectively performed, it helps to maintain structural integrity and human functioning and contributes to human development.…”

“…For example, reduced loading and disuse of weightbearing muscles lead to both muscle atrophy and bone demineralization. 7 Researchers conducted two studies on antepartum physical and psychosocial symptoms during hospital bed rest among women with either a singleton or multiple pregnancy. 8,9 The number of symptoms weekly reported by women treated with bed rest during hospitalization was significantly higher (M=9 per week) compared to a healthy control group and did not change throughout the treatment.…”