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
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
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 through , 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.
SMFM has released guidance to address the use of bed rest or activity reduction for complications of pregnancy. Based on current evidence, SMFM provides important recommendations for the role of activity restriction and obstetric care.
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
Evidence: No studies available to determine impact on preterm labor rates and cord prolapse risks
Recommendation (weak): Activity restriction should not be prescribed
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
Potential Maternal Risks Associated with Activity Restriction
Research in nonpregnant patients has demonstrated physiologic changes associated with reduced mobility, including
Altered organ perfusion
Shift in abdominal contents that may impact respiration
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
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
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