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CMECNE

SMFM: Guidance on Reduced Activity and Bed Rest for Pregnancy Complications

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. State the SMFM guidelines for activity restrictions related to complications of pregnancy
2. Discuss potential risks to a pregnant patient, placed on activity restriction or bedrest

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.

The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 07/15/2021 through 07/15/2023, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

SUMMARY:

Based on current evidence, SMFM provides important recommendations for the role of activity restriction and obstetric care.

Definitions

Definitions of activity restriction and bedrest used in studies differ | Universal standards are lacking
Can vary from total bed rest with bathroom allowance to a few hours of activity per day

Recommendations for Specific Pregnancy Complications

Preterm Birth (Singleton)
- Evidence: Limited and relatively low quality| Does not support benefit
- Recommendation (strong): Against routine use of any activity restriction for prevention of preterm birth as defined by symptoms, arrested preterm labor, or shortened cervix
Hypertensive Disorders of Pregnancy
- Evidence: Limited data
- Recommendation: Activity restriction should not be prescribed
PPROM
- Evidence: No studies available to determine impact on preterm labor rates and cord prolapse risks
- Recommendation (weak): Activity restriction should not be prescribed
Multiple Gestation
- Evidence: High quality | Multiple RCTs, including Cochrane Reviews that demonstrate lack of benefit for the prevention of preterm birth
- Recommendation (strong): Against activity restriction
Fetal Growth restriction (FGR)
- Evidence: Moderate quality evidence | Limited data
- Recommendation (weak): Activity restriction should not be prescribed

KEY POINTS:

Potential Maternal Risks Associated with Activity Restriction

Research in nonpregnant patients has demonstrated physiologic changes associated with reduced mobility, including
- Fluid shifts
- Altered organ perfusion
- Electrolyte abnormalities
- Hormonal changes
- Shift in abdominal contents that may impact respiration
- Muscle atrophy
- Loss of physical fitness
Specific to pregnancy: Similar negative outcomes have also been demonstrated including
- Loss of muscle and bone mass
- Impair normal weight gain in both mother and fetus
- Increased risk for GDM
- Increased risk for VTE
- Significant psychosocial risks: Increased stress and anxiety, which may manifest with physical symptoms | May impact patient’s family and personal relationships as well

Learn More – Primary Sources:

Society for Maternal-Fetal Medicine (SMFM) Consult Series #50: The role of activity restriction in obstetric management

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SMFM: Guidance on Reduced Activity and Bed Rest for Pregnancy Complications