Restless legs syndrome and pregnancy: A review

Srivanitchapoom, Prachaya; Pandey, Sanjay; Hallett, Mark

doi:10.1016/j.parkreldis.2014.03.027

Cited by 74 publications

(78 citation statements)

References 80 publications

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“…47 If symptoms persist, and the maternal benefit outweighs any risks to the fetus, other treatment options may include dopaminergic drugs, benzodiazepines, opioids, or antiepileptic agents. 12,48 A recent consensus guideline provides further recommendations for the treatment of RLS in pregnancy. 47 In summary, RLS is common in pregnant women and our findings demonstrate a significant role for RLS in poor sleep quality, excessive daytime sleepiness, and poor daytime function, which are common symptoms frequently attributed to pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Restless Legs Syndrome and Sleep-Wake Disturbances in Pregnancy

Dunietz

Lisabeth²,

Shedden³

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: To estimate the association of restless legs syndrome (RLS) and its frequency with sleep-wake disturbances in pregnancy. Methods: A cohort of 1,563 women in their third trimester of pregnancy were recruited from prenatal clinics between March 2007 and December 2010. Demographic, pregnancy, and delivery data were extracted from medical records and sleep information was collected with questionnaires. To diagnose RLS, we used standardized criteria of RLS symptoms and frequency that were developed by the International Restless Legs Study Group. Logistic regression models were constructed to investigate the association of RLS and its frequency with sleep-wake disturbances (poor sleep quality, daytime sleepiness, poor daytime function) and delivery outcomes. Results: Overall 36% of the pregnant women had RLS, and half had moderate to severe symptoms. Compared to women without RLS, those with RLS were more likely to have poor sleep quality (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.7-2.9), poor daytime function (OR 1.9, 95% CI 1.4-2.4), and excessive daytime sleepiness (OR 1.6, 95% CI 1.3-2.0). A dose-response relationship also was evident between RLS frequency and each of the sleep-wake disturbances. There was no evidence for any association between RLS and delivery outcomes. Conclusions: RLS is a significant contributor to poor sleep quality, daytime sleepiness, and poor daytime function, all common and often debilitating conditions in pregnancy. Obstetric health care providers should be aware of these associations and screen women for RLS. I NTRO DUCTI O NRestless legs syndrome (RLS), also known as Willis-Ekbom disease, is a sensorimotor disorder composed of an urge to move, with or without associated discomfort that occurs with inactivity and improves with movement. It follows a circadian pattern, with a predilection for the evening and night.1 RLS is a common, underdiagnosed condition that affects up to 5% of the population worldwide, 2-4 with up to 15% prevalence in Caucasians. 5 The prevalence of RLS is positively correlated with age and body mass index (BMI) among both men and women.6,7 Although RLS has a genetic predisposition, it is also associated with other conditions such as end-stage renal disease, neuropathy, and pregnancy. 8 RLS affects up to one-third of pregnant women 9,10 peaks in the third trimester, 9-11 and usually subsides after delivery. 11Multiparous women are affected up to three times more often than nulliparous women. 10 The high prevalence of RLS during pregnancy has been attributed to hemodynamic and hormonal changes, iron and folate metabolism, and psychomotor behaviors.12 Although RLS is related to reduced quality of life and poor sleep in the general population 13,14 data on RLSassociated maternal sleep-wake disturbances are lacking. pregnancy and delivery outcomes (eg, preterm delivery, prolonged labor, cesarean section deliveries, and postpartum depression). [15][16][17] Therefore, the goal of this study was twofold: (1) to examine the frequency of RLS in ...

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Section: Discussionmentioning

confidence: 99%

Restless Legs Syndrome and Sleep-Wake Disturbances in Pregnancy

Dunietz

Lisabeth²,

Shedden³

et al. 2017

Journal of Clinical Sleep Medicine

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“…The high demand for iron by the fetus can lead to a rapid decline in maternal iron stores and low ferritin levels. For the biological plausibility of iron therapy, iron is needed as a cofactor in the synthesis of dopamine 36 . Hence, dopamine synthesis may be reduced if iron levels are low increase in RLS severity during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Open-label study of the efficacy and safety of intravenous ferric carboxymaltose in pregnant women with restless legs syndrome

et al. 2015

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Open-label study of the efficacy and safety of intravenous ferric carboxymaltose in pregnant women with restless legs syndrome, Sleep Medicine (2015), http://dx.doi.org/doi: 10.1016/j.sleep.2015.08.006. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Neurocenter of Southern Switzerland (Lugano). Patient and Methods:Nineteen women in the third trimester of pregnancy with moderateto-severe RLS and serum ferritin levels <35 µg/L or hemoglobin (Hb) <11.0 g/dl were included in the study. RLS was graded according to the International Restless Legs Syndrome (IRLS) Study Group rating scale. All participants had a score of ≥20 or had RLS ≥3 times/week. Depending on Hb levels, 500 or 700 mg of FCM was administered over 20 min. The primary endpoint was a ≥50% reduction in the mean IRLS score 1 week after FCM infusion. Secondary endpoints included periodic limb movements (PLMs; assessed using nocturnal foot actigraphy), sleep quality (assessed using the Pittsburgh Sleep Quality Index), and safety. Results:The IRLS score decreased from 23 ± 7 (baseline) to 13 ± 7 (P < 0.01), whereas the PLM index decreased from 35 ± 26 (baseline) to 25 ± 20 (P < 0.001). Significant improvement in sleep quality was also reported (P < 0.029), and treatment was well tolerated. Three serious adverse events were reported but were considered unrelated to treatment. Conclusions:These data provides promising evidence of the safety and efficacy of FCM for moderate-to-severe RLS in pregnant women with iron deficiency or anemia. A future placebo-controlled study is therefore warranted.

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“…The prevalence of RLS during pregnancy appears to be approximately 2-3 times higher than in non-pregnant women (66). Why RLS increases during pregnancy is not fully understood.…”

Section: Paradigm Of Questions For Epidemiology Studies Of Rlsmentioning

confidence: 97%