Choosing Wisely:

Don’t routinely recommend activity restriction or bed rest during pregnancy for any indication.

Rationale and Comments: Bed rest or activity restriction has been commonly recommended for a variety of conditions in pregnancy including multiple gestation, intrauterine growth restriction, preterm labor, premature rupture of membranes, vaginal bleeding, and hypertensive disorders in pregnancy. However, information to date does not show an improvement in birth outcome with the use of bed rest or activity restriction, but does show an increase in loss of muscle conditioning and thromboembolic disease.
Sponsoring Organizations:
  • American College of Obstetricians and Gynecologists
  • Sources:
  • Cochrane Database of Systematic Reviews
  • Disciplines:
  • Obstetrical
  • References: • McCall CA, Grimes DA, Lyerly AD. “Therapeutic” bed rest in pregnancy: unethical and unsupported by data. Obstet Gynecol. 2013;121:1305–8.
    • Fox NS, Gelber SE, Kalish RB, Chasen ST. The recommendation for bed rest in the setting of arrested preterm labor and premature rupture of membranes. Am J Obstet Gynecol. 2009;200:165.e1–165.e6.
    • Grobman WA, Gilbert SA, Iams JD, Spong CY, Saade G, Mercer BM, et al. Activity restriction among women with a short cervix. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Obstet Gynecol. 2013;121:1181–6.
    • Maloni JA. Lack of evidence for prescription of antepartum bed rest. Expert Rev Obstet Gynecol. 2011;6:385–93.
    • Brennan MC, Moore LE. Pulmonary embolism and amniotic fluid embolism in pregnancy. Obstet Gynecol Clin North Am. 2013;40:27–35.
    • Promislow JH, Hertz-Picciotto I, Schramm M, Watt-Morse M, Anderson JJ. Bed rest and other determinants of bone loss during pregnancy. Am J Obstet Gynecol. 2004;191:1077–83.
    • Merriam AA, Chichester M, Patel N, Hoffman MK. Bed rest and gestational diabetes: more reasons to get out of bed in the morning [abstract]. Obstet Gynecol. 2014;123(suppl 1):70S.
    • Sosa CG, Althabe F, Belizán JM, Bergel E. Bed rest in singleton pregnancies for preventing preterm birth. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD003581.
    • Sciscione AC. Maternal activity restriction and the prevention of preterm birth. Am J Obstet Gynecol. 2010;202:232.e1–e5.

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