By: Laurie Edwards for Fibroids1Its very name implies rest and relaxation. But for many pregnant women, bed rest is hugely disruptive, something they would only do if pregnancy complications dictated it – and for pregnant women with uncontrolled high blood pressure, very often bed rest is the recommended course of action.
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Learn more about bed rest, blood pressure and pregnancy:
How high is too high? Blood pressure readings of 140/90 for women with previously normal blood pressure in considered too high.
Readings of 160/110 or more could indicate preeclampsia, a serious complication.
Bed rest itself has risks for pregnant women: Blood clots, muscle weakness and joint pain, as well financial stresses due to missed work.
Always discuss your options with your physician. Since there is no clear answer yet, some degree of bed rest may still be the best option for you. |
But according to researchers, it isn’t clear yet that putting hypertensive women on bed rest will improve their outcomes. Since an estimated six to eight percent of pregnancies experience such complications and high blood pressure disorders are the leading cause of pregnancy-related death, this latest news has far-reaching implications.“Despite the fact that bed rest is recommended quite often in clinical practice, very few well-designed trials have evaluated its effectiveness,” said University of Liverpool researcher Shireen Meher, MDBS. “Until there is good evidence to show that bed rest is beneficial, it should not be recommended routinely in clinical practice for pregnant women,” she added.
Bed rest can mean anything from limiting exercise and more strenuous exercise to completely avoiding movement, literally staying in bed. Sometimes, women are put on bed rest for a brief time until things stabilize, while others may remain bedridden for months until delivery.
Though some women already have high blood pressure going into the pregnancy, others develop hypertension as a result of being pregnant. By putting these women on bed rest and limiting movement, physicians hope to minimize the daily fluctuations in blood pressure that go along with hypertension.
Five percent of pregnant women with high blood pressure experience a serious and potentially fatal complication known as preeclampsia, usually diagnosed after the twentieth week of pregnancy. In addition to elevated blood pressure (140/90 or more in women who used to have normal blood pressure), women with preeclampsia have protein in their urine.
In the most severe cases of preeclampsia (blood pressure of 160/110 or higher), both the mother and the baby’s lives can be in danger, and the only cure is the delivery of the baby.
Meher and colleagues published their review of four clinical trials involving bed rest in a recent issue of the Cochrane Collaboration, a nonprofit international organization that specializes in medical research. Two of the studies involved women hospitalized with preeclampsia and compared those with partial bed rest with those women put on full bed rest – no significant differences were found in hypertension or birth outcomes.
The other two studies involved women with hypertension but not preeclampsia, and showed some reduced risk of pre-term delivery for women taking some rest versus those going about normal daily activities.
Factors that can’t be ignored in evaluating bed rest are the complications that come along with it. Staying still for so long increases the risk of blood clots, muscle atrophy and bone demineralization. Many women have to stop working earlier than expected, adding financial stress to an already stressful pregnancy.
“Much of the push for bed rest came in the period from 1950 to 1960 when hypertensive disease in pregnancy was a cause of significant mortality and morbidity for mother and infant. At the time there was neither good medication for intervention nor methods for monitoring the fetus for well-being or compromise,” said Dr. Sharon Phelan of the University of New Mexico and spokesperson for the American College of Obstetrics and Gynecology.
Now, says Phelan, there are better medications to control blood pressure and more effective ways of monitoring the fetus. Also, the prognosis for preterm babies born four to six weeks earlier is much more promising than it was decades ago.
Still, with the evidence unclear, many experts continue to use bed rest for their hypertensive patients.
“The bottom line is that we still recommend bed rest to many, many women who have blood pressure disorders or mild preeclampsia, to flatten out blood pressure throughout the day… It makes sense that this should make a difference, but we don’t know with certainty that it will change outcomes one iota,” said Dr. John T. Repke, chairman of obstetrics and gynecology at Penn State College of Medicine-Milton S Hershey Medical Center.
