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

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