Let’s begin with the important point that most pregnancies complicated by hypertension or pre-eclampsia end with a healthy mom and baby. Still, preeclampsia is a serious complication of pregnancy and should not be taken lightly. The Preeclampsia Foundation offers the following information:
Preeclampsia is a disorder that occurs only during pregnancy and the postpartum period and affects both the mother and the unborn baby. Affecting at least 5-8% of all pregnancies, it is a rapidly progressive condition characterized by high blood pressure and the presence of protein in the urine….Typically, preeclampsia occurs after 20 weeks gestation (in the late 2nd or 3rd trimesters or middle to late pregnancy) and up to six weeks postpartum, though in rare cases it can occur earlier than 20 weeks….Globally, preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths each year.
Their information is now a little out of date. In November, the American College of Obstetricians and Gynecologists (ACOG) issued a press release on a new task force report on preeclampsia. The press release notes a number of important points from the report:
- Protein in the urine is no longer a requirement for diagnosing preeclampsia.
- The rate of preeclampsia in the US has increased 25% in the last two decades and is a leading cause of maternal and infant illness and death.
- Women who have chronic hypertension, have had preeclampsia in a previous pregnancy, are 35 or older, are carrying more than one fetus, have diabetes or kidney disease, are obese, are African American, or have certain immune disorders are at increased risk of developing preeclampsia.
- The cure for preeclampsia begins with delivery of the baby.
- Potentially dangerous outcomes of preeclampsia include preterm delivery, severe hypertension, stroke, and seizures.
- If a woman had preeclampsia in a previous pregnancy, the risk of a recurrence can be as high as 50%.
If you read the entire task force report, it also discusses bed rest as a treatment for preeclampsia. Here is what it says:
- There is no evidence that bed rest or salt restriction reduces preeclampsia risk. (p. 3)
- For women with gestational hypertension or pre- eclampsia without severe features, it is suggested that strict bed rest not be prescribed. (p. 5)
- Although bed rest has been suggested as a preventive strategy, the evidence for this is scarce. The only two studies located that evaluated bed rest as a preventive strategy were both small (32 participants and 72 participants) and did not evaluate perinatal and maternal morbidity and mortality and adverse effects of bed rest. However, regular exercise has been hypothesized to prevent preeclampsia by improving vascular function. (p. 29).
- [B]ed rest should not routinely be recommended for management of hypertension in pregnancy. In addition, prolonged bed rest for the duration of pregnancy increases the risk of thromboembolism. (p. 33)
As Noted by McCall et al, in the article “‘Therapeutic’ Bed Rest in Pregnancy: Unethical and Unsupported by Data,” given the lack of evidence for bed rest, prescribing bed rest in pregnancy is not only unethical, but also a form of medical injustice. This is not to say that a woman might not want to take it easy if it makes her feel better, but that lying in bed is unlikely to help but more likely to cause harm.
Here is a summary of the task force’s recommendations :
- Screening to predict preeclampsia beyond taking an appropriate medical history to evaluate for risk factors is not recommended.
- Vitamin C or vitamin E to prevent preeclampsia is not recommended.
- Daily low-dose aspirin to help prevent preeclampsia is suggested in very high-risk women with a history of preeclampsia and preterm delivery.
- Antihypertensive medication is recommended for severe hypertension during pregnancy.
- A decision to deliver should not be based on the amount of proteinuria or change in the amount of proteinuria.
- The use of magnesium sulfate is recommended for severe preeclampsia, eclampsia, or HELLP syndrome.
A woman’s health must be as paramount in pregnancy as it is when she is not pregnant. Evidence based recommendations and informed consent/shared decision making are the path to justice in maternity care.