Restless Legs Syndrome and Sleep Disturbance during Pregnancy: The Role of Folate and Iron

Abstract

Restless legs syndrome (RLS) is a neurosensory disorder that typically begins in the evening and often prevents a person from falling asleep. It has been associated with iron deficiency anemia and dopaminergic pathways and is often treated with iron infusion or dopamine agonists. The purpose of this secondary analysis of longitudinal data collected on women before, during, and after pregnancy is to document the prevalence of RLS during pregnancy, contrast its effect on sleep and mood state, and explore the role of folate and iron in the expression of RLS, specifically during the third trimester when the syndrome is most distressing. The prevalence increased from 0 during preconception to 23% (n = 7) during the third trimester of pregnancy. Only 1 subject continued to experience RLS after delivery. Compared with those without complaints of restless legs, those with restless legs had low serum ferritin at preconception and significantly lower folate levels during preconception and at each trimester. In addition, time to sleep onset was significantly delayed and depressed mood was significantly higher in the RLS group. Rather than indicators of iron deficiency anemia (serum ferritin, serum iron, and hemoglobin) or pernicious anemia (vitamin B(12)), it was reduced serum folate level that was associated with RLS in this sample of pregnant women. Findings indicate a need to reconsider recommendations about the normal ranges of serum ferritin and serum folate levels during pregnancy to minimize the complaints of restless legs and promote more consolidated sleep and better daytime mood state during pregnancy.

086 Restless Legs Syndrome – A Study of Prevalence Among Medical School Faculty Members

“…This confronts our results which indicate a significantly lower mean age in individuals with RLS 20 . Some conditions, such as anemia, pregnancy and chronic renal failure, are associated with increased prevalence, reaching rates up to 25 and 30% 21,22 .…”

Prevalence of Willis-Ekbom Disease/Restless Legs Syndrome During Pregnancy: A Review

“…This yielded 131 articles in Pub Med. Of these, 16 were peer-reviewed articles specifically dealing with the prevalence of WED/RLS during pregnancy and were written in the English language; these 16 articles, spanning 1945 -2012, were included in this review ( Table 1) [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31].…”

“…Six studies had participants who completed self-administered questionnaires [17][18][19][20][25][26][27], another seven conducted face to face interviews [16, 21-24, 26, 29, 31], and three studies did not specify how data was collected [28,30,31].…”

“…One study examined the first and third trimesters [19], while another examined the second and third trimesters [23]. Four studies collected data during all three trimesters [21,25,27,28]. Two studies did not specify when data was collected [30,31].…”

“…All four of the 1995 International Restless Legs Syndrome Group (IRLSSG) criteria for the diagnosis of WED/RLS were used in one study [26,32], while two studies used one criterion [27,28,32]. In 2003, after revision of the IRLSSG criteria for the diagnosis of WED/RLS, ten studies used all four criteria [16,[17][18][19][20][21][22][23][24][25]32].…”