Tuesday, May 22, 2012

Treatment options: Bedrest

While recent research into the causes and mechanisms of preeclampsia has been very exciting and informative, finding a treatment has been painfully slow. No one wants to be responsible for harming unborn babies, so developing new medications is done very cautiously if at all. Instead, the focus has been on fairly innocuous treatments like low dose aspirin, dietary supplements, and lifestyle changes. I plan to feature these over the next few days. Keep in mind, I am not a doctor. This is provided for information only. Please consult your health care provider before starting or stopping any treatment plan.

Bedrest has been the go-to advice for many pregnancy complications including preeclampsia since the 1950s, a time when there was little else to be done to control high blood pressure in pregnancy, when there was no way to monitor the baby for adverse effects like growth restriction, and when there was a poor outlook for any baby born before 36 weeks.

Today, there are ways to manage high blood pressure with medication, the baby can be monitored with regular ultrasound, and preemies are much more likely to survive. However, bedrest remains a common recommendation for women with preeclampsia. There was little evidence to support it in the '50s, and little quality research has been done since then.

This 2005 review of four studies found no reduction in the perinatal death rate (the death of a baby before, during, or shortly after birth) and no improvement in low birth weights for women on bedrest for PE. Two of the reviewed studies did show improved outcomes for mothers with severe hypertension. One study found no difference in outcomes between partial bedrest or full bedrest, although it doesn't explain what is meant by partial bedrest. Two studies found a small improvement in the rates of severe hypertension among women who had no protein in the urine, and a marginal improvement in preterm birth among the same population.

This review also pointed out the cost of bedrest: loss of income for mothers previously working, increased risk of blood clots, muscle atrophy and bone demineralization, general inconvenience. Based on this review, it appears the costs of bedrest outweigh the benefits.

More recently, this 2008 study looked at women on hospital bedrest for reasons other than PE (preterm labor, premature rupture of membranes, incompetent cervix, etc) to see how their rates of PE compared to women not on bedrest. The result: a significantly reduced risk of developing PE and a lower risk of intrauterine growth restriction. The conclusion: "When strictly adhered to, bedrest may be an effective measure in the prevention of preeclampsia and early intrauterine growth restriction."

My non-scientist take on this study: these women were on bedrest before any sign of PE showed. Since 90% of women never get PE at all, and most of those who do so get it only in a first pregnancy without any other known risk factors, it would be impractical to put this into practice. How would you know ahead of time which women would benefit? However, for someone like me who has a history of PE more than once, has several known risk factors, and would be at high risk in any future pregnancy, it could be beneficial to start bedrest before any symptoms show. This also may become more relevant in the future when an early detection test is finally developed.

Ultimately, bedrest remains controversial and under-studied as a possible prevention or treatment for PE, though it is a popular recommendation.

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