Prenatal bed rest in developed and developing regions: a systematic review and meta-analysis

Abstract

Background: Bed rest is prescribed by most maternity health care professionals for high-risk pregnancy complications, but the impact of bed rest at home and in hospital has not been explored. Our aim was to quantify the influence of bed rest on maternal/fetal health outcomes in developed and developing regions.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials. We conducted a structured search through MEDLINE, Embase, CINAHL, Web of Science and the Cochrane Library through Mar. 7, 2019. Trials comparing standard care to standard care plus bed rest after 20 weeks' gestation were assessed. Outcomes included infant birth weight, being small for gestational age, gestational age, premature or very premature birth, perinatal death, admission to the neonatal intensive care unit, preterm rupture of membranes, hypertensive disorders of pregnancy, preeclampsia and gestational diabetes mellitus.

Results: We identified 1191 publications, of which 43 were assessed for eligibility. Sixteen publications reporting on 14 unique studies (2608 women, 3328 infants) were included in the analysis. Overall, maternal/newborn outcomes were similar between women on bed rest and those not on bed rest. In subgroup analyses of developed and developing regions, length of gestation was shorter with bed rest (weighted mean difference -0.77 wk, 95% confidence interval [CI] -1.26 to -0.27, I 2 = 0%), and the risk of a very premature birth was increased (risk ratio 2.07, 95% CI 1.15 to 3.73, I 2 = 0%) in developed countries.

Interpretation: In developed regions, treatment of complicated pregnancies with more than 1 week of bed rest results in worse newborn outcomes. Additional studies are required to determine whether bed rest or hospital admission improves outcomes in developing regions. PROSPERO Trial registration number: CRD42018099237.

Conflict of interest statement

Competing interests: None declared.

Copyright 2019, Joule Inc. or its licensors.

Figures

Figure 1:

Flow diagram showing study selection.

Figure 2:

Effect of bed rest (experimental) versus no bed rest (control) on perinatal death. Note: CI = confidence interval, df = degrees of freedom, M–H = Mantel–Haenszel.

Figure 3:

Effect of bed rest (experimental) versus no bed rest (control) on very preterm birth. The study by Bigelow and colleagues was removed owing to its influence on heterogeneity (heterogeneity of developed regions subgroup p < 0.001; 100% event rate in both study arms). Note: CI = confidence interval, df = degrees of freedom, M–H = Mantel–Haenszel.

Figure 4:

Effect of bed rest (experimental) versus no bed rest (control) on gestational age. Note: CI = confidence interval, df = degrees of freedom, IV = inverse variance, SD = standard deviation.