Restless Legs Syndrome In Pregnancy Research Articles

Restless legs syndrome in pregnancy: A case responding to glucocorticosteroids

Restless legs syndrome in pregnancy: A case responding to glucocorticosteroids

Characteristics and determinants of restless legs syndrome in pregnancy

The aim of this cohort study was to prospectively assess frequency, characteristics, and determinants of restless legs syndrome (RLS) in pregnancy and its impact on sleep. Pregnant women were prospectively studied in each trimester and 8 weeks postpartum. Assessments included interview about RLS symptoms and sleep disturbances; standardized sleep-wake questionnaires including the International Restless Legs Syndrome Scale (IRLSS) and the Pittsburgh Sleep Quality Questionnaire (PSQI); actigraphic recording of periodic limb movements (PLM); and blood tests including levels of hemoglobin, ferritin, and estrogen. RLS was diagnosed in 58 of 501 women (12%). Positive family history was found in 37% of women with RLS; 59% reported onset of RLS symptoms before the 20th week; 45% had an IRLSS >20 and 100% had a PSQI >5. Hemoglobin levels <11 g/dL were found in 20% of both affected and unaffected women in the third trimester. Women with and without RLS had similar hemoglobin, ferritin, and estrogen levels. IRLSS and PLM in sleep dropped by more than 50% postpartum in women with RLS. We found lower prevalence and earlier onset of symptoms compared to previous studies and confirmed significant improvement after delivery. RLS is clinically relevant due to severe impact on sleep quality. Genetic factors and smoking, but not ferritin, anemia, or estrogen levels, seem to play a role in the pathophysiology of RLS in pregnancy.

Sleep in Women

The timing and continuity of sleep in healthy individuals is regulated by the synchronous function of the sleep homeostasis and the endogenous circadian rhythms. Multiple factors affect these two processes and the way they interact. Sleep disorders may manifest differently in men and women and these differences are particularly notable during pregnancy, lactation, and menopause. Insomnia may occur relatively commonly during pregnancy and in the postpartum, and may be the result of either a primary sleep disorder, such as obstructive sleep apnea (OSA), movement disorders such as restless legs syndrome (RLS), or sometimes depression, especially in the postpartum period. Obstructive sleep apnea may contribute to a higher risk of hypertension during pregnancy and doubles the risk for preeclampsia and preterm birth. Snoring, a frequent symptom of OSA, increases in frequency during pregnancy. Restless legs syndrome is more common in pregnant women, is more frequent in the third trimester of pregnancy, and tends to improve dramatically after delivery. Factors associated with increased RLS in pregnancy may be related to iron and folate metabolism. Risk for OSA increases after menopause and presentation with insomnia can delay the diagnosis of OSA. Various treatment options for sleep disorders in women are discussed.

Restless legs syndrome in pregnancy is a frequent disorder with a good prognosis

The aim of this study was to assess the prevalence of restless legs syndrome in pregnancy. We distributed a questionnaire to 541 consecutive postpartum patients and received answers from 251 (46%) women. Of the participants, 34% reported restless legs syndrome in pregnancy. In 97% of the women in whom restless legs syndrome had started during the pregnancy, the symptoms disappeared within two to three days after delivery. There was no correlation between pregnancy-related restless legs syndrome and low hemoglobin levels in the first trimester, and the incidence of restless legs syndrome was not affected by use of iron supplementation. We conclude that in our population, restless legs syndrome in pregnancy is both frequent and transient, occurring in approximately one in three pregnancies and typically resolving within a few days after delivery.

A common sleep disorder in pregnancy: Restless legs syndrome and its predictors

Restless legs syndrome (RLS) is common in the third trimester of pregnancy. In this case-control study, 22.5% of 211 women had RLS. The RLS cases had a history of growing pains (GP) more frequently than controls (P=0.042). A family history of GP (P=0.025) and RLS (P=0.018) was more frequent among cases than controls. RLS in pregnancy is predicted by family history of RLS and GP, and by childhood history of GP.

Restless legs syndrome and pregnancy in Kayseri, Turkey: A hospital based survey

The prevalence of restless legs syndrome (RLS) is low in the general population in Turkey. To assess the prevalence of RLS in pregnancy, a hospital-based survey assessing symptoms of RLS and other sleep problems was performed through face-to-face interviews and physical examination on 983 pregnant women from 11 hospitals in the two urban and four suburban areas of Kayseri, Turkey, at the time of delivery and 6 months after delivery. RLS is diagnosed clinically by means of the four essential criteria of the International RLS Study Group. A total of 103 women reported the occurrence of RLS symptoms during pregnancy, giving an RLS prevalence rate of 10.48%, with presence of symptoms more than three times per month, which decreased to 2.9% after 6 months. A significant relationship was observed between RLS and the number of previous pregnancies: women who had one child were compared with women who had 2–3 children (odds ratio [OR] = 1.441, 95% confidence interval [CI], 0.894–2.324), and women who had ≥4 children (OR = 2.530, 95% CI, 1.377–4.650). Patients with and without the RLS syndrome were similar in respect to distributions of age, income level, career, iron and folate therapy, sleep habits, and sleep problems. The prevalence of RLS among pregnant women is low, like the low prevalence in the general population in Eastern European and/or Asian populations.

Predictors of restless legs syndrome in pregnancy: A hospital based cross sectional survey from Pakistan

Restless legs syndrome (RLS) is more common in pregnant women. The objective of our study was to determine frequency of RLS in pregnant women and predictors of RLS in pregnancy in Pakistan. All pregnant women admitted at The Aga Khan University Hospital for delivery from June to July 2005 were enrolled. Eighty-one of 271 (30%) interviewed women fulfilled the diagnostic criteria of RLS. One hundred seventeen (43%) of the subjects dropped their haemoglobin during the pregnancy. No significant difference in haemoglobin drop was noted between the RLS group and healthy group. On multivariate analysis family history of RLS (OR: 8.43, CI: 2.32–30.57, p value < 0.001), history of RLS in prior pregnancy (OR: 53.74, CI: 6.72–429.8, p value < 0. 001), history of RLS in past even when non-pregnant (OR: 12.91, CI: 3.34–49.87, p value < 0.001) and haemoglobin of 11 g/dL or less (OR: 2.05, CI: 1.04–4.04, p value 0.036) were found to be independent predictors of RLS during pregnancy. Subgroup analysis revealed that family history of RLS (OR: 3.06, CI: 1.2–7.83, p value 0.019) and anemia (OR: 1.89, CI: 0.96–3.71, p value 0.06) were associated with de novo RLS, and family history of RLS (OR: 12.39, CI: 4.45–35.54, p value < 0.001) and multiparity (OR: 6.84, CI: 2.15–21.71, p value 0.001) were predictors of pre-existing RLS.

MOTHERISK ROUNDS: Medications for Restless Legs Syndrome in Pregnancy

According to epidemiological data, pregnant women have a two or three times higher risk of experiencing restless legs syndrome (RLS) than the general population. Current evidence suggests that dopaminergic dysfunction, impaired iron homeostasis, and genetic predisposition may be involved in the pathophysiology of RLS. Four classes of medications have been used for patients with RLS, but pregnancy elicits a therapeutic concern. Although two dopamine agonists, ropinirole and pramipexole, have been approved by the FDA for the treatment of RLS and are currently the first-line treatment for daily symptoms, there is very little information on the teratogenic risks of these new medications. Therefore, they are not currently recommended for use during pregnancy. Medications with a more extensive safety record in pregnancy include opioids; antiepileptics, such as carbamazepine and gabapentin; and certain benzodiazepines. Ruling out iron deficiency should be an integral part of a treatment plan for RLS in pregnancy. Before management with medication is introduced, every patient should be assessed for iron status with measurement of serum ferritin.

Predisposing factors of restless legs syndrome in pregnancy

The occurrence of restless legs syndrome in pregnancy is well known. However, the mechanism of this association is unclear. In this study, we aimed to identify the factors that predispose women to have restless legs syndrome during pregnancy. A total of 146 pregnant women were included in the study. Patients were asked questions regarding demographic characteristics, complications of pregnancy, medical therapy (vitamin and iron intake), sleep disorders, muscle cramps, and excessive daytime sleepiness. Electroneurography, routine blood biochemistry tests, complete blood count, and thyroid function tests were performed and vitamin B12, folic acid, serum iron, iron-binding capacity, ferritin, iron saturation, prolactin, estradiol, and progesterone were measured. Of the participants, 38 were diagnosed as having restless legs syndrome. In women with restless legs syndrome, additional medical problems, night cramps, and excessive daytime sleepiness were more frequent. In women without restless legs syndrome, serum hemoglobin levels were significantly higher and the use of supplemental iron or vitamins was greater. Among the women with restless legs syndrome, progesterone levels were slightly higher but this difference was not statistically significant. In summary, in this study, lower hemoglobin levels and supplementation deficits of iron and vitamins were found be the risk factors for restless legs syndrome in pregnancy.

Intravenous Magnesium Sulfate May Relieve Restless Legs Syndrome in Pregnancy

We report a case of restless legs syndrome that improved after intravenous magnesium sulfate administration. A 34-year-old gravida 1 para 0 woman, with a 13-year history of restless legs syndrome, was prescribed bed rest due to pre-term labor at 26 weeks. While at rest, the subject experienced severe restless legs syndrome. The subject was later admitted to the hospital for pre-term labor. Treatment for pre-term labor included intravenous magnesium sulfate. RLS symptoms completely resolved during treatment, beginning the first day of administration. Studies involving intravenous magnesium treatment for restless legs syndrome have not included pregnant women. The authors propose that intravenous magnesium sulfate may alleviate restless legs syndrome in some pregnant women.

Restless Legs Syndrome

Restless Legs Syndrome (RLS) is a well-defined symptom complex and is frequently associated with sleep disturbance and a recognized family history. It occurs either as idiopathic RLS or in association with many medical, neurological or vascular disorders. The neurological examination and routine investigations in idiopathic RLS are normal. Polysomnography supports the diagnosis of RLS by documenting the associated sleep disturbances and periodic limb movements in sleep (PLMS). Although MRI studies disclose no intracerebral lesions, recent Positron Emission Tomography (PET) and single photon emission computed tomography (SPECT) studies point to some involvement of the basal and red nuclei and the cerebellum. No definitive etiology is known for this condition, but several pathophysiological mechanisms have been proposed. There is supportive evidence that RLS is a Central Nervous System (CNS) dysfunction, suggesting widespread involvement of the descending dopaminergic (DA) pathways, possibly originating in the diencephalon or upper brainstem. This is corroborated by the successful treatment of RLS with DA agents, sedatives, and neurotransmitters. However, RLS can also occur with spinal disorders and spinal cord lesions implying the existence of a spinal generator. The incidence of RLS in pregnancy is well known and its association with vascular disorders supports another mechanism in some patients. The primary treatment of RLS is largely symptomatic and quite effective with DA agents, DA agonists, opioids and other neurotransmitters. The treatment of RLS associated with various diseases is aimed at the correction of the underlying pathological or deficiency states. Antidepressant medications frequently precipitate or worsen the condition of RLS.

Folate Deficiency and Restless-Legs Syndrome in Pregnancy

Folate Deficiency and Restless-Legs Syndrome in Pregnancy