Not enough evidence to recommend routine bed rest for hypertension in pregnancy

Currently there is a lack of evidence that keeping pregnant women with high blood pressure in bed for a prolonged period of time improves the chance of a healthy delivery. Prolonged bed rest is disruptive to women's lives, carries the risk of generating blood clots, and may be expensive.

Women who are pregnant and have high blood pressure are frequently advised to restrict their activity. This may extend to full bed rest in hospital for some. Before such recommendations can be made, there should be clear evidence that bed rest improves the chance of giving birth to a healthy child, because the procedure is disruptive, risks generating blood clots, and may be costly.

A systematic review, however, found that despite the widespread practice, few people had conducted research to see if it is indeed beneficial. The Cochrane Review Authors found four small research trials that involved 449 women. At best, bed rest appeared to have only a marginal effect on preventing blood pressure rising even further or the risk of giving birth prematurely. However, these data need to be confirmed in larger, well designed trials.

One trial showed that, compared to women whose activity was not restricted, more women who had extended bed rest said they would not do it again in future pregnancies.

‘At present there is insufficient evidence to provide clear guidance for clinical practice. Therefore, bed rest should not be recommended routinely for hypertension in pregnancy,” says lead author Shireen Meher, a research fellow in the Division of Perinatal and Reproductive Medicine, at The University of Liverpool, UK.