Although physicians have long recommended bed rest or restricted activity for pregnant women with hypertension, a systematic review of available studies found only weak evidence that this practice benefits women or their children.
In the review, published by the Cochrane Collaboration, Dr. Shireen Meher of the University of Liverpool (UK), and colleagues were able to identify only four studies involving a total of 449 women that directly addressed this issue (Cochrane Database of Systematic Reviews 2005, Issue 4, Art. No. CD003514.pub2. DOI: 10.1002/14651858.CD003514.pub2).
Two of the studies enrolled women hospitalized for preeclampsia (proteinuric hypertension) and compared some rest with strict bed rest. These two trials failed to find any significant differences between the groups on any measure.
The other two trials, one of which the authors described as having “uncertain” quality, compared some bed rest in the hospital with routine activity at home for nonproteinuric hypertension. One of those studies found the risk of severe hypertension reduced by 42% and the risk of preterm birth reduced by 47% in women getting some bed rest in the hospital.
Although those results reached statistical significance, the clinical significance remains unclear, concluded the authors. The results had very wide confidence intervals: 11%–62% reduced risk of severe hypertension and 1%–71% reduced risk of preterm birth.
There were no statistically significant differences between the groups on many other potential outcomes, including miscarriage, perinatal death, severe preeclampsia, placental abruption, elective delivery, endotracheal intubation, and infants who were small for their gestational age.
None of the studies reported any adverse events associated with bed rest. Potential adverse events include thrombosis, muscle atrophy, and bone demineralization.
In addition to these negative medical consequences, bed rest may have other types of negative effects. None of the included studies examined the financial implications of bed rest for women, their families, and the health care system.
The authors concluded that the published studies provide insufficient evidence to provide clear guidance for clinical practice. Thus, they wrote, the evidence base does not support the routine recommendation of bed rest for hypertension in pregnancy.
Bed rest, a time-honored treatment for hypertension during pregnancy is of little benefit, a study review concludes. Stanford W. Carpenter