Maternal Bed Rest and Infant Health

Negative shocks to early child health influence both short- and long-run outcomes. Interventions prior to birth, rather than early in childhood, may reduce the probability or the severity of the shock and may be relatively cost effective. One such intervention, bed rest during pregnancy, is frequently prescribed to reduce the likelihood of preterm birth. Premature infants experience worse average initial infant health than full-term infants and these differences may persist into adulthood without mediation. Recent medical literature on the efficacy of bed rest is mixed, but tilts towards a negative or zero relationship between bed rest and infant health, suggesting that this intervention does not improve initial health status. This is not surprising given the difficulty of navigating a crucial threat to identification: conditions leading to bed rest recommendations are correlated with infant health. We investigate this question using Pregnancy Risk Assessment Monitoring System (PRAMS) data. Among women who experience a medical issue during pregnancy, we compare outcomes of infants born to mothers who are observationally similar yet differ in whether they are recommended bed rest. Using OLS and matching methods, we find a positive relationship between bed rest and the likelihood of low birth weight and prematurity (consistent with prior medical literature). Yet our results also show that bed rest decreases the incidence of very low birth weight (at least −15.4 percent), very premature outcomes (at least −7.7 percent), and a reduction for infant death. We provide additional evidence that suggests bed rest shifts initial health status upward. Our back-of-the-envelope calculations suggest that when accounting for cost savings over both the short and the long run, bed rest may be more cost-effective treatment than post-birth interventions.