Merriam AA, Chichester M, Patel N, Hoffman MK
Obstet Gynecol 2014 May;123 Suppl 1:70S
PMID: 24770257
Abstract
INTRODUCTION: Activity restriction or “bed rest” is a commonly prescribed obstetric intervention, which lacks data demonstrating efficacy. Complications including bone demineralization, pulmonary atelectasis, venous thromboembolism, and muscle deconditioning have been attributed to bed rest. Exercise has a known beneficial effect toward achieving good glycemic control in women with gestational diabetes mellitus (GDM). We sought to quantitate the effect that bed rest has on GDM.
METHODS: We performed a retrospective cohort study from 2007 to 2012 at a large tertiary hospital. Charts for women with singleton pregnancies who were admitted for 7 days or longer with diagnosis codes for preterm labor, cervical shortening, preterm premature rupture of membranes, advanced cervical dilation, and preeclampsia were identified. Those who had their 1-hour screening Glucola test during admission were included. Logistic regression analysis was done to determine the effect of bed rest on GDM.
RESULTS: Five hundred nine women were available for inclusion. Fifty-four were diagnosed with gestational diabetes during a prolonged hospital stay (10.6%). Patient characteristics between the two groups were similar. Maternal age (relative risk 2.66, P=.008) and maternal length of stay (relative risk 6.13, P=0.00) were associated with the development of GDM. For every day a patient was admitted to the hospital on bed rest, their risk of GDM increased 1.04 times.
CONCLUSION: Antenatal bed rest increases the risk of acquiring GDM. The association between bed rest and GDM is biologically plausible because skeletal muscle is the primary site of maternal insulin resistance. Activation of these muscles has been shown to increase insulin sensitivity and decrease blood glucose levels. This finding supports the mounting evidence that bed rest does more harm than good.