TOPLINE

Bed rest and activity restriction (BAR) are recommended in nearly half of US pregnancies, with more than 1 in 3 low-risk pregnancies receiving such recommendations despite professional society guidance against routine use. Among low-risk pregnancies, lifting restrictions affect more than 20% of patients, while exercise and walking or standing restrictions each affect more than 15%.

METHODOLOGY

• Researchers conducted a cross-sectional study using an internet-based survey distributed in July 2024 to individuals aged 18-54 years who were currently pregnant or had been pregnant in the past year in the US.
• A total of 1500 respondents from 49 states and Washington, DC, completed the survey, which was developed and pilot-tested by maternal-fetal medicine and epidemiology specialists.
• Participants were recruited via Pollfish, a survey platform using random device engagement methodology through partner mobile applications, and results were weighted by age and race/ethnicity to the 2022 US Natality Database. 
• Respondents were asked about BAR recommendations by healthcare providers, whether their pregnancy was considered high-risk, and specific pregnancy conditions. 
• Logistic regression was used to identify factors independently associated with BAR recommendations.

TAKEAWAY

• The weighted prevalence of BAR recommendations was 46.2% overall, with 65.3% among high-risk pregnancies and 33.3% among low-risk pregnancies. 
• Among low-risk pregnancies, specific restriction types included bed rest (7.1%), activity restriction (28.0%), lifestyle restriction (17.9%), lifting (20.4%), exercise (15.7%), and walking or standing restrictions (15.5%).
• Pregnancy complications independently associated with BAR included medical problems before pregnancy (adjusted odds ratio [aOR], 2.20; 95% CI, 1.41-3.41), medical problems during pregnancy (aOR, 2.01; 95% CI, 1.31-3.11), patient-reported advanced maternal age (aOR, 1.84; 95% CI, 1.15-2.93), and history of preterm birth (aOR, 1.81; 95% CI, 1.24-2.64).
• A sensitivity analysis showed no evidence of an association between gestational age (first trimester, second trimester, or third trimester/postpartum) and BAR (P = .20). 

IN PRACTICE

“This persistence is concerning given known harms of BAR including thromboembolism, bone loss, deconditioning, and psychological effects on patients and families, with no demonstrated benefit for preventing preterm birth or improving pregnancy outcomes,” the authors of the study wrote.

SOURCE

This study was led by Beth L. Pineles, MD, PhD, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia. It was published online in the American Journal of Obstetrics and Gynecology.

LIMITATIONS

This study was deemed exempt by the University of Pennsylvania Institutional Review Board, and the response rate could not be calculated, as Pollfish does not provide counts of users invited or screened. The cross-sectional design limits the ability to establish temporal relationships between pregnancy conditions and BAR recommendations. The use of nonprobability sampling through an internet-based survey platform may introduce selection bias, although results were weighted by age and race/ethnicity to the 2022 US Natality Database to address this concern. The reliance on self-reported data regarding pregnancy risk status and specific pregnancy conditions may be subject to recall bias or misclassification.

DISCLOSURES

The Foundation for Society for Maternal-Fetal Medicine/American Association of Obstetricians and Gynecologists Foundation Scholarship Award provided funding for this study to Pineles. The funder had no involvement in study design, data collection, analysis, interpretation, writing of the report, or the decision to submit for publication. No relevant conflicts of interest were reported by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.