Restless legs syndrome and pregnancy

Sleep Disorders Center, Department of Neurology, Vita-Salute University, IRCCS H.S. Raffaele, Milan, Italy.
Neurology (Impact Factor: 8.29). 10/2004; 63(6):1065-9. DOI: 10.1212/01.WNL.0000138427.83574.A6
Source: PubMed


To perform a large and detailed epidemiologic study on restless legs syndrome (RLS) during pregnancy and the puerperium.
A structured clinical interview, assessing symptoms since the beginning of pregnancy, was performed to a population of 642 pregnant women at the time of delivery and at follow-up evaluation (1, 3, and 6 months after delivery). Main hematologic tests were also evaluated. A woman was considered affected if she met the International RLS Study Group criteria for RLS diagnosis.
Twenty-six percent of women were affected by RLS during their pregnancy. The disease was strongly related to the third trimester of pregnancy and tended to disappear reaching the time of delivery. Affected women presented lower values of hemoglobin and mean corpuscular volume compared with healthy subjects (both groups received the same supplemental iron and folate therapy).
Pregnancy is associated with transient restless legs syndrome.

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    • "Untreated gRLS leads to severe sleep fragmentation, poor sleep quality, insomnia, and reduced quality of life. [44] [48] [60] Fragmented sleep, as discussed in the next section, can result in a host of peripartum complications. "
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    ABSTRACT: Insufficient sleep is common in the general population, and can result from environmental and psychosocial factors, medical and psychiatric disorders, and sleep disorders, such as insomnia, circadian rhythm disorders, sleep apnoea and restless legs. Women are particularly at risk for sleep disorders, and complaints of sleep disturbance are more prevalent among women than men across the life span. During the perinatal period, many common sleep disorders, such as obstructive sleep apnoea or restless legs may be exacerbated, or in the case of insomnia or narcolepsy, treatment options may change. In addition, the role of circadian rhythms in fertility and perinatal health is just beginning to be appreciated. In this chapter, we provide an overview of the current knowledge of the unique aspects of diagnosis and treatment of sleep disorders during the perinatal period.
    Best practice & research. Clinical obstetrics & gynaecology 10/2013; 28(1). DOI:10.1016/j.bpobgyn.2013.09.003 · 1.92 Impact Factor
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    • "The interviews were conducted by general physicians (researchers) who were trained on RLS. The diagnosis of RLS was established based upon the 4 criteria of the International Restless Legs Syndrome Study Group (IRLSSG) [2]: desire to move the limbs, usually associated with paresthesias/dysesthesias; onset or exacerbation with rest; partial or complete relief by activity; and onset or worsening of symptoms during night time. Pregnant women were considered to have a diagnosis of RLS only if they clearly fulfilled all 4 criteria. "
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    ABSTRACT: To investigate the prevalence of restless legs syndrome (RLS) during pregnancy and to evaluate factors associated with RLS in a population of Iranian pregnant women. In the present cross-sectional study, 443 consecutive pregnant women admitted for delivery underwent an interview within 2days of parturition. The diagnosis of RLS was established by the 4 criteria of the International Restless Legs Syndrome Study Group (IRLSSG). The severity of RLS was assessed through the IRLSSG Rating Scale. Seventy-nine (17.8%) women met the RLS diagnostic criteria, with most (74.7%) having RLS of moderate severity. The mean RLS duration before delivery was 3.1±2.1months among 69 (87.3%) women; 10 (12.7%) had RLS onset before pregnancy. Sleep disturbances including insomnia and early awakening were significantly more common among women with RLS than among those without (P<0.001), and the frequency of cesarean delivery was also significantly higher (58.2% versus 44.5%, P=0.027; odds ratio 2.4). There were no significant differences between the 2 groups in terms of age, number of pregnancies, folate and iron supplementation, hemoglobin level, and neonatal anthropometric data. Restless legs syndrome is common during pregnancy and is associated with poor sleep and an increased risk of cesarean delivery.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 07/2013; 123(1). DOI:10.1016/j.ijgo.2013.04.023 · 1.54 Impact Factor
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    • "Several aspects of a patient’s life can be influenced by RLS, including difficulty with sleep initiation and maintenance, mood, cognitive function, and quality of life.7–9 While primary (idiopathic) RLS affects the majority of patients with this disorder, secondary RLS can also occur in patients with predisposing conditions, including iron deficiency, chronic renal failure, and pregnancy.10–12 "
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    ABSTRACT: Gabapentin enacarbil XR is a new extended-release formulation which attempts to overcome the reduced efficacy of shorter-acting gabapentin, with sustained delivery over a 24-hour period. It is a gabapentin prodrug which is efficiently and rapidly converted to gabapentin during active transport throughout the length of the intestine via high-capacity monocarboxylate type 1 nutrient transporters unlike its predecessor, which is absorbed via low-capacity transporters largely confined to the upper intestinal region. Its lack of saturable absorption allows for dose-proportional absorption and hence increased bioavailability. Several clinical trials addressing its efficacy in moderate to severe restless legs syndrome (RLS) demonstrate improvements in the International RLS Rating Scale after a 2-week to 3-month period. Open-label studies of 52 weeks' duration showed maintenance of symptom reduction with once-daily administration of the extended-release formulation. The most commonly reported treatment-emergent adverse effects were somnolence and dizziness. Although the incidence of emergent adverse effects is high, it is comparable with that of gabapentin. No studies thus far have documented augmentation as an issue, unlike that observed with most dopaminergic agents. In addition, both dopamine precursors and agonists have not been shown to increase slow wave sleep or improve overall sleep architecture consistently despite improvement in the periodic leg movement index, in contrast with gabapentin enacarbil. Presently, gabapentin enacarbil has not been approved by the Therapeutic Goods Administration or Medsafe for use in RLS. The cost of this medication may also be a potential barrier for many patients. Future comparative efficacy studies with gabapentin, first-line dopaminergic agents, rotigotine, being the other once daily RLS medication, and pregabalin, the structural analog of gabapentin, will be necessary.
    Therapeutics and Clinical Risk Management 05/2012; 8:201-8. DOI:10.2147/TCRM.S24436 · 1.47 Impact Factor
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