(976) National Prevalence of Healthcare Provider-Recommended Bedrest and Activity Restriction by Pregnancy Condition

Bedrest and activity restriction (BAR) are often recommended in pregnancy despite an association with worse pregnancy outcomes. With guidelines recommending against BAR, some consider it an issue of the past, yet the contemporary national prevalence remains unknown. We aimed to determine the contemporary national prevalence of healthcare provider-recommended BAR among pregnant individuals, the pregnancy conditions associated with these recommendations, and adherence to BAR.

Study Design:

An internet-based survey was distributed to females aged 18-54 who were pregnant or had been pregnant in the past year. The survey was tested and validated. Participants were asked, “Has anyone recommended bedrest or advised you to do less physical activity?,” in addition to details about these recommendations, whether their pregnancy was considered, “high-risk,” and their pregnancy conditions. The primary outcome was a recommendation for BAR by an obstetrician-gynecologist or midwife. To account for differential response rates, weighting for age and race/ethnicity was performed based on the target population of all births in the 2022 U.S. Natality Database, and all results presented are weighted. Two-sided p< 0.05 was considered statistically significant.

 

Results:

1500 survey responses were obtained. After weighting, 539 (38%) participants reported high-risk pregnancies. The frequency of BAR was 40% (95% confidence interval [CI] 37-43%); greater in high-risk pregnancies [61% (95% CI 57-65%)] than low-risk pregnancies [27% (95% CI 24-30%)], p-value< 0.01. Frequency of recommendations and recommendation type varied by pregnancy condition (chi-squared p < 0.01, Table). Adherence to BAR varied by both pregnancy condition and restriction type, with most participants across groups adherent (p values < 0.01, Figure).

Conclusion:

Despite clear national guidelines recommending against BAR, recommendations for BAR practices remain prevalent, especially among high-risk pregnancies but common even among low-risk pregnancies. Future studies should focus on the deimplementation of this prevalent and harmful practice.