Article

Frequency and predisposing factors of leg cramps in pregnancy: A prospective clinical trial

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Abstract

Background: Leg cramp is the painful contraction of the muscles that often occurs at night. Pregnancy is the most common cause of muscle cramps that usually occur in the second trimester of pregnancy. Although the reasons of the spasms had not been determined, the imbalance between the absorption and elimination of serum electrolytes such as Ca, Mg and potassium and also insufficiency of some vitamins and probably the changes in activities of motor neurons of spinal cord, can be the source of these problems. The aim of this study was the evaluation of frequency and predisposing factors of leg cramps. Methods: In a cross sectional descriptive analytic study, a group of 400 women in the third trimester of pregnancy were asked to record the symptoms of leg cramp. Their education level and job recorded and their total serum level of Ca and Mg was measured in the first visit. Exclusion criteria included systemic medical conditions such as thyroid disease, diabetes, osteoporosis and prenatal disorders such as gestational diabetes mellitus and preeclampsia and patient cooperation. Results: In our study the prevalence of leg cramp was 54.75%. There was a statistically significant relationship between leg cramp and serum level of magnesium (p=0.04). There was no relation between calcium serum level and leg cramp (p=0.294). The women's age, their nutritional habits and individual characteristics were not signifycantly related to occurrence of leg cramp. Conclusion: Leg cramp is a common symptom in pregnancy and in patients with low serum levels of magnesium, a magnesium supplement can be helpful.

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... 2 be between 47. 8 and 64.4% in studies conducted in the USA, Iran, and India. [3][4][5][6] The estimated fertility rate in Jordan is 3.5 children per woman, 7 with increased pregnancy-related complications like gestational diabetes and preterm labor among women. 7 However, there is a paucity of literature investigating the prevalence of leg cramps in Jordan or any other Middle Eastern country. ...
... 11 One cross-sectional study found a statistically significant relationship between the occurrence of leg cramps and serum levels of magnesium (Mg) but no relationship with calcium (Ca) serum levels, age, nutritional habits, or individual characteristics. 3 A more recent cross-sectional study reported a significant relationship between the occurrence of leg cramps in pregnancy and decreased sleep quality. 12 Given these limited studies, there is a need for further investigation into other comprehensive biopsychosocial factors that could be associated with leg cramps during pregnancy. ...
... This finding aligns with similar studies conducted in India, Iran, and the USA, where the prevalence of leg cramps among pregnant women in the third trimester ranged from 47.8% to 64.6%. [3][4][5][6] Understanding the prevalence of leg cramps in different populations is crucial for healthcare providers to offer appropriate support and management strategies for pregnant women experiencing this common issue. ...
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Objective This study aimed to estimate the prevalence and determine predictors of leg cramps among pregnant women in their third trimester. Methods A sample of pregnant women in their third trimester who routinely visited local clinics in Jordan was recruited. Participants completed a socio-demographic and clinical characteristics questionnaire, the numeric pain rating scale (NPRS) for leg cramp pain intensity, the Arabic version of the Pregnant Physical Activity Questionnaire (PPAQ), the Nordic Musculoskeletal Questionnaire (NMQ), Short Form Health Survey (SF-12), Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HADS). In addition, magnesium (Mg) and calcium (Ca) serum levels were examined. Logistic regression analyses were used to identify predictors of leg cramps occurrence. A linear regression model was used to investigate predictors of leg cramps pain intensity among pregnant women who reported leg cramps. Results Two hundred and five (n=205) pregnant women completed the study. The estimated prevalence of leg cramps was 58%. Logistic regression results showed that not receiving assistance with housework (OR 0.46, p=0.025), progress in the number of gestational weeks (OR 1.10, p=0.021), the number of previous pregnancies (OR 1.21, p=0.049), having leg swelling (OR 2.28, p=0.019), and having gastrointestinal (GIT) problems (OR 2.12, P=0.046) were associated with a higher odds of leg cramps occurrence. In the subsample with pregnant women with leg cramps, linear regression results showed that pregnant women with high school education versus elementary school (β=0.70, p=0.012), number of working hours (β=0.11, p=0.010), using vitamins supplements (β=−1.70, p=0.043), having diabetes after pregnancy (β=1.05, p=0.036), having sciatica (β=0.58, p=0.028), having hip pain (β =−.33, p=0.029), and higher PSQI total score (β=0.09, p=0.020) were the significant predictors of leg cramp pain intensity. Conclusion Many health-related conditions, as well as work and home-related work characteristics, may be considered risk factors for the occurrence of leg cramps and increased leg cramps pain intensity in pregnancy.
... [24] Muscle cramps The prevalence of muscle cramps was 54.8%. This is similar to the prevalence of 54.7% reported by Sohrabvand et al., [25] however, it was lower than the prevalence of 65.8% reported in an Indian study. [5] Ireland et al. [1] reported a much lower prevalence of 15-30% in the second half of pregnancy. ...
... The imbalance between the absorption and elimination of serum electrolytes such as magnesium seen with increasing gestational age which causes changes in the activities of motor neurons may explain this observation. [25,26] In addition, dehydration may also be responsible for muscle cramps in the 3 rd trimester. [27] Maternal age, parity, and BMI of the participants did not affect the prevalence of muscle cramps among the participants. ...
... Previous studies have reported an increased weakness of muscles, weaker proprioception, and laxity of the ligaments as pregnancy progresses. [25,28] We also noted that the prevalence of arthralgia in pregnancy was associated with increasing maternal age. This may be explained by the increased risk of degenerative joints diseases associated with increasing age. ...
Article
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Background: Pregnancy usually triggers a wide range of changes that result in a variety of musculoskeletal disorders (MSDs). The scope and burden of these disorders in Nigeria are not known. Aim: The study aimed to determine the prevalence and risk factors of pregnancy-related MSDs in Enugu. Patients and methods: A cross-sectional study of pregnant women attending antenatal clinics at three tertiary hospitals in Enugu, Nigeria, was done using an observer-administered questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 22. Results: A total of 317 participants were studied. A majority of the participants (93.1%) had one or more MSDs. Low back pain (LBP) and muscle cramps were the two most common pregnancy-related MSDs with prevalence rates of 56.8 and 54.8%, respectively. Increasing gestational age (P = 0.001), previous pregnancies (P = 0.027), and occupation (P = 0.018) were associated with increased risk of MSDs. A majority of the MSDs were of mild and moderate severity and 10.4% of the participants had significant impairment of their daily activities. Conclusion: MSDs are common in pregnancy with LBP and muscle cramps as the most prevalent conditions. Increasing gestational age, multigravidity, and occupation increased the risk of MSDs among our cohorts. Preventive and therapeutic measures should be instituted when necessary to ensure optimal maternal health during pregnancy.
... In 3 observational studies of pregnant women, low serum magnesium concentrations were associated with greater muscle cramping. [95][96][97][98] In a prospective cohort study of 160 pregnant women, the proportion experiencing leg cramps during pregnancy was 69% in those with a serum magnesium concentration below 0.52 mmol/L and 25% in those with a concentration ≥0.52 mmol/L; P < .001. 95 Similar associations were seen in 2 other studies, even when serum magnesium concentrations were within the normal reference range (0.65-1.05 mmol/L). ...
... 95 Similar associations were seen in 2 other studies, even when serum magnesium concentrations were within the normal reference range (0.65-1.05 mmol/L). [96][97][98] For example, in a cross-sectional study of 400 pregnant women in their third trimester, women who experienced any cramps vs no cramps had a lower mean concentration of serum magnesium (0.78 vs 0.82 mmol/L, respectively; P < .05). 98 In contrast, 1 prospective cohort study reported no significant difference in the mean concentration of serum magnesium in women who experienced any cramps vs no cramps (serum magnesium concentration of 0.67 vs 0.70 mmol/L, respectively). ...
... [96][97][98] For example, in a cross-sectional study of 400 pregnant women in their third trimester, women who experienced any cramps vs no cramps had a lower mean concentration of serum magnesium (0.78 vs 0.82 mmol/L, respectively; P < .05). 98 In contrast, 1 prospective cohort study reported no significant difference in the mean concentration of serum magnesium in women who experienced any cramps vs no cramps (serum magnesium concentration of 0.67 vs 0.70 mmol/L, respectively). 96 ...
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Purpose of review Strategies to mitigate muscle cramps are a top research priority for patients receiving hemodialysis. As hypomagnesemia is a possible risk factor for cramping, we reviewed the literature to better understand the physiology of cramping as well as the epidemiology of hypomagnesemia and muscle cramps. We also sought to review the evidence from interventional studies on the effect of oral and dialysate magnesium-based therapies on muscle cramps. Sources of information Peer-reviewed articles. Methods We searched for relevant articles in major bibliographic databases including MEDLINE and EMBASE. The methodological quality of interventional studies was assessed using a modified version of the Downs and Blacks criteria checklist. Key findings The etiology of muscle cramps in patients receiving hemodialysis is poorly understood and there are no clear evidence-based prevention or treatment strategies. Several factors may play a role including a low concentration of serum magnesium. The prevalence of hypomagnesemia (concentration of <0.7 mmol/L) in patients receiving hemodialysis ranges from 10% to 20%. Causes of hypomagnesemia include a low dietary intake of magnesium, use of medications that inhibit magnesium absorption (eg, proton pump inhibitors), increased magnesium excretion (eg, high-dose loop diuretics), and a low concentration of dialysate magnesium. Dialysate magnesium concentrations of ≤0.5 mmol/L may be associated with a decrease in serum magnesium concentration over time. Preliminary evidence from observational and interventional studies suggests a higher dialysate magnesium concentration will raise serum magnesium concentrations and may reduce the frequency and severity of muscle cramps. However, the quality of evidence supporting this benefit is limited, and larger, multicenter clinical trials are needed to further determine if magnesium-based therapy can reduce muscle cramps in patients receiving hemodialysis. In studies conducted to date, increasing the concentration of dialysate magnesium appears to be well-tolerated and is associated with a low risk of symptomatic hypermagnesemia. Limitations Few interventional studies have examined the effect of magnesium-based therapy on muscle cramps in patients receiving hemodialysis and most were nonrandomized, pre-post study designs.
... 7 About 30%-50% of women experience muscle cramps during their pregnancy, often several times per week, with a variable duration ranging from few seconds to several minutes and occurring mostly during the night. 42 The cause(s) for this association remain(s) uncertain, but contributing factors (also common outside the context of pregnancy) include metabolic disturbances, electrolyte imbalances and vitamin deficiencies. 1 43 Treatable causes of muscle cramps should be identified and treated if possible. ...
Article
Muscle cramps are painful, sudden, involuntary muscle contractions that are generally self-limiting. They are often part of the spectrum of normal human physiology and can be associated with a wide range of acquired and inherited causes. Cramps are only infrequently due to progressive systemic or neuromuscular diseases. Contractures can mimic cramps and are defined as shortenings of the muscle resulting in an inability of the muscle to relax normally, and are generally myogenic. General practitioners and neurologists frequently encounter patients with muscle cramps but more rarely those with contractures. The main questions for clinicians are: (1) Is this a muscle cramp, a contracture or a mimic? (2) Are the cramps exercise induced, idiopathic or symptomatic? (3) What is/are the presumed cause(s) of symptomatic muscle cramps or contractures? (4) What should be the diagnostic approach? and (5) How should we advise and treat patients with muscle cramps or contractures? We consider these questions and present a practical approach to muscle cramps and contractures, including their causes, pathophysiology and treatment options.
... It shows that there were significant differences between two groups in all items related to nutritional life style as intake of food rich vitamins, rich in calcium, rich in protein, rich in iron, decrease salty and spicy food, this is in agreement with. [25] In their study about the relation between nutritional life style and leg cramp found that there was a significant improvement in women receiving vitamin B, magnesium and calcium comparing with control group. [15] Who suggested that, treatment, preventing and curing pain associated with leg cramps during pregnancy including taking Vitamins B1, B6, E, and C and magnesium. ...
Article
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Leg cramps are a common discomfort during pregnancy account 30-50% of pregnant women. Lifestyle intervention help in reducing symptoms and discomfort associated with leg cramps. Aim: Was to study the effectiveness of lifestyle intervention for reducing leg cramps among pregnant women. Research Design: A quasi-experimental design was used. Setting: This study was conducted in Outpatient Clinic at Obstetric and Gynecological Department affiliated at Benha Teaching Hospital. Sampling: A purposive sample of 212 pregnant women having leg cramps and divided into study and control group. Tools: Three tools were used for collecting data; 1) A structured interviewing questionnaire; it includes four parts personal characteristics of studied women, past and current obstetric history, leg cramps history, and studied women's knowledge. 2) Modified Healthy Life Style Assessment Scale. 3) Visual analogue Scale. Results: showed that the mean age in the studied group and control group were 27.06±6.45 & 26.98±7.43 respectively. And secondary education is the education level of the large proportion of both study and control group 49.1% & 57.5% respectively, there was highly significant differences between two groups in all items related to their knowledge p<0.001. Also, there were significant differences between two groups in all items related to nutritional life style, rest and sleep in addition exercise, physical activity and intensity of leg cramps pain(p<0.001). Conclusion: implementation of lifestyle intervention was effective in improving pregnant women's Lifestyle, through improving their knowledge and decreasing the severity and frequency of leg cramps. Recommendation: The nurses should provide all pregnant women at antenatal clinics with a self-care guideline about lifestyle intervention for reducing leg cramps during pregnancy to improve their awareness. Keywords: lifestyle intervention, leg cramps, pregnancy
... It has also been observed that pregnant women have lower serum magnesium levels than nonpregnant women (8), indicating that pregnancy cramps may be related to low magnesium levels. Although the cause of muscle cramps is not fully understood, neuromuscular changes, weight gain, joint looseness, decreased blood flow to the lower extremities, and increased pressure on the leg muscles during the last trimester of pregnancy are all potential contributing factors (3,9). ...
... In the healthy adult population, the incidence of muscle cramping is 50-60%. There is no difference between gender, except for pregnant women, in which the incidence is 30-50% (Sohrabvand and Karimi, 2009). Moreover, other studies reported high prevalence of muscle cramping in elderly and in endurance athletes (Naylor and Young, 1994). ...
Article
Exercise-Associated Muscle Cramps (EAMC) are a common painful condition of muscle spasms. Despite scientists tried to understand the physiological mechanism that underlies these common phenomena, the etiology is still unclear. From 1900 to nowadays, the scientific world retracted several times the original hypothesis of heat cramps. However, recent literature seems to focus on two potential mechanisms: the dehydration or electrolyte depletion mechanism, and the neuromuscular mechanism. The aim of this review is to examine the recent literature, in terms of physiological mechanisms of EAMC. A comprehensive search was conducted on PubMed and Google Scholar. The following terminology was applied: muscle cramps, neuromuscular hypothesis (or thesis), dehydration hypothesis, Exercise-Associated muscle cramps, nocturnal cramps, muscle spasm, muscle fatigue. From the initial literature of 424 manuscripts, sixty-nine manuscripts were included, analyzed, compared and summarized. Literature analysis indicates that neuromuscular hypothesis may prevails over the initial hypothesis of the dehydration as the trigger event of muscle cramps. New evidence suggests that the action potentials during a muscle cramp are generated in the motoneuron soma, likely accompanied by an imbalance between the rising excitatory drive from the muscle spindles (Ia) and the decreasing inhibitory drive from the Golgi tendon organs. In conclusion, from the latest investigations there seem to be a spinal involvement rather than a peripheral excitation of the motoneurons.
... Leg cramps were reported by 3.5% of our pregnant subjects and 3.2% of the non-pregnant subjects. While leg cramps were more common than RLS symptoms in our study sample, it is uncommon when compared with reports from Caucasian and Asian populations where more than half of pregnant women and adults in the general population complain of nocturnal leg cramps [26]. There was no difference in the report of leg cramps between our pregnant and non-pregnant subjects. ...
Article
Objectives: The prevalence of RLS in pregnancy is higher when compared with the general population however it remains unknown among indigenous black Africans. Available data indicate that RLS is uncommon in sub-Saharan Africa. We embarked on this study to determine the prevalence and characteristics of RLS in an antenatal clinic sample of Nigerian pregnant women compared with a primary care sample of non-pregnant women. Methods: A total of 310 pregnant women and non-pregnant women filled out a questionnaire which incorporated the 2014 minimal criteria of the International Restless Legs Syndrome Study Group. Demographic and clinical data, including sleep duration and samples for blood hemoglobin concentration and urinalysis were obtained. Results: The mean ages of the pregnant and non-pregnant women were 24.9 ± 5.6 years and 23.6 + 5.4 years, respectively (p = 0.003). There was no case of RLS found among pregnant women while five (1.6%) of the non-pregnant women fulfilled the criteria for RLS. Overall, the prevalence report of RLS symptoms was associated with lower mean habitual nocturnal sleep duration (p < 0.05) coffee (p = 0.013) and kola nut (0.023) consumption, report of leg cramps (p < 0.001) and proteinuria (p = 0.047), Report of leg cramps and proteinuria were independently associated with RLS. Conclusion: The prevalence of restless legs syndrome is low among women of child-bearing age in the Nigerian population and may be lower in pregnancy. Report of leg cramps and proteinuria are independently associated with RLS.
... Magnesium supplement for the same (Sohrabvand and Karimi, 2009). The 76% of patients took regular iron and calcium in our study while 5% had developed intolerance to iron tablets. ...
Article
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“Every pregnancy faces risks” with occurrence of various signs and symptoms including danger signs during antepartum, intrapartum and postpartum phases which require regular antenatal services. The current retrospective study was aimed to assess the prevalence of signs/symptoms of pregnancy. It was being conducted in Obstetrics Department, Punjab Institute of Medical Sciences, Jalandhar (India) during April to June, 2012. Socioeconomic variables, parity, antenatal care and event outcomes were explored. Majority of mothers belonged to 21-30 years age group (75.00%) and middle socioeconomic status (67.00%). 42% mothers conceived within year of marriage and were referred from periphery (57.00%). 44% suffered from Nausea and Vomiting of Pregnancy whereas, anorexia reported among 12% women. 76% mothers took regular iron and calcium while 5% reported intolerance to iron tablets. 61% and 22% mothers experienced ankle edema in second and third trimester, respectively. Backache, leg cramps, abdominal pain and increased urinary frequency was complained in 47%, 14%, 33% and 50% mothers, respectively. Similarly, 32% experienced constipation and discharge per vaginum was seen among 12% mothers. While, 03%, 05%, 13% and 16% of mothers had leakage per vaginum, bleeding per vaginum, urinary tract infection and headaches, respectively. Various unusual signs/symptoms appear during pregnancy due to physiological hormonal changes. If ignored, they may lead to complications which may prove dangerous for mother and baby. Pregnant women should be able to recognize these symptoms and approach for emergency care for the same. Education programs should be promoted to enhance knowledge of danger signs among pregnant females including family members. Key words: Antenatal Care, Danger signs, Education programs, Emergency Care, Referred
Article
Background: Leg cramps are a common problem in pregnancy. Various interventions have been used to treat them, including drug, electrolyte and vitamin therapies, and non-drug therapies. This Cochrane Review is an update of a review first published in 2015. Objectives: To assess the effectiveness and safety of different interventions for treating leg cramps in pregnancy. Search methods: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (25 September 2019), and reference lists of retrieved studies. Selection criteria: Randomised controlled trials (RCTs) of any intervention for the treatment of leg cramps in pregnancy compared with placebo, no treatment or other treatments. Quinine was excluded for its known adverse effects. Cluster-RCTS were eligible for inclusion. Quasi-RCTs and cross-over studies were excluded. Data collection and analysis: Three review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The certainty of the evidence was assessed using the GRADE approach. Main results: We included eight small studies (576 women). Frequency of leg cramps was our primary outcome and secondary outcomes included intensity and duration of leg cramps, adverse outcomes for mother and baby and health-related quality of life. Overall, the studies were at low or unclear risk of bias. Outcomes were reported in different ways, precluding the use of meta-analysis and thus data were limited to single trials. Certainty of evidence was assessed as either low or very-low due to serious limitations in study design and imprecision. Oral magnesium versus placebo/no treatment The results for frequency of leg cramps were inconsistent. In one study, results indicated that women may be more likely to report never having any leg cramps after treatment (risk ratio (RR) 5.66, 95% confidence interval (CI) 1.35 to 23.68, 1 trial, 69 women, low-certainty evidence); whilst fewer women may report having twice-weekly leg cramps (RR 0.29, 95% CI 0.11 to 0.80, 1 trial, 69 women); and more women may report a 50% reduction in number of leg cramps after treatment (RR 1.42, 95% CI 1.09 to 1.86, 1 trial, 86 women, low-certainty evidence). However, other findings indicated that magnesium may make little to no difference in the frequency of leg cramps during differing periods of treatment. For pain intensity, again results were inconsistent. Findings indicated that magnesium may make little or no difference: mean total pain score (MD 1.80, 95% CI -3.10 to 6.70, 1 trial, 38 women, low-certainty evidence). In another study the evidence was very uncertain about the effects of magnesium on pain intensity as measured in terms of a 50% reduction in pain. Findings from another study indicated that magnesium may reduce pain intensity according to a visual analogue scale (MD -17.50, 95% CI -34.68 to -0.32,1 trial, 69 women, low-certainty evidence). For all other outcomes examined there may be little or no difference: duration of leg cramps (low to very-low certainty); composite outcome - symptoms of leg cramps (very-low certainty); and for any side effects, including nausea and diarrhoea (low certainty). Oral calcium versus placebo/no treatment The evidence is unclear about the effect of calcium supplements on frequency of leg cramps because the certainty was found to be very low: no leg cramps after treatment (RR 8.59, 95% CI 1.19 to 62.07, 1 study, 43 women, very low-certainty evidence). In another small study, the findings indicated that the mean frequency of leg cramps may be slightly lower with oral calcium (MD -0.53, 95% CI -0.72 to -0.34; 1 study, 60 women; low certainty). Oral vitamin B versus no treatment One small trial, did not report on frequency of leg cramps individually, but showed that oral vitamin B supplements may reduce the frequency and intensity (composite outcome) of leg cramps (RR 0.29, 95% CI 0.11 to 0.73; 1 study, 42 women). There were no data on side effects. Oral calcium versus oral vitamin C The evidence is very uncertain about the effect of calcium on frequency of leg cramps after treatment compared with vitamin C (RR 1.33, 95% CI 0.53 to 3.38, 1 study, 60 women, very low-certainty evidence). Oral vitamin D versus placebo One trial (84 women) found vitamin D may make little or no difference to frequency of leg cramps compared with placebo at three weeks (MD 2.06, 95% CI 0.58 to 3.54); or six weeks after treatment (MD 1.53, 95% CI 0.12 to 2.94). Oral calcium-vitamin D versus placebo One trial (84 women) found oral calcium-vitamin D may make little or no difference to frequency of leg cramps compared with placebo after treatment at three weeks (MD -0.30, 95% CI -1.55 to 0.95); and six weeks (MD 0.03, 95% CI -1.3 to 1.36). Oral calcium-vitamin D versus vitamin D One trial (84 women) found oral calcium-vitamin D may make little or no difference to frequency of leg cramps compared with vitamin D after treatment at three weeks (MD -1.35, 95% CI -2.84 to 0.14); and six weeks after treatment (MD -1.10, 95% CI -2.69 to 0.49). Authors' conclusions: It is unclear from the evidence reviewed whether any of the interventions provide an effective treatment for leg cramps. This is primarily due to outcomes being measured and reported in different, incomparable ways so that data could not be pooled. The certainty of evidence was found to be low or very-low due to design limitations and trials being too small to address the question satisfactorily. Adverse outcomes were not reported, other than side effects for magnesium versus placebo/no treatment. It is therefore not possible to assess the safety of these interventions. The inconsistency in the measurement and reporting of outcomes meant that meta-analyses could not be carried out. The development of a core outcome set for measuring the frequency, intensity and duration of leg cramps would address these inconsistencies and mean these outcomes could be investigated effectively in the future.
Article
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness and safety of different interventions for leg cramps in pregnancy.
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Background This study intended to determine the effects of Vitamin D and calcium-Vitamin D in treating leg cramps in pregnant women. Materials and Methods This study was conducted as a double-blind randomized controlled clinical trial on 126 participants, 18–35-year-old pregnant women with a minimum of two leg cramps per week who were referred to health-care centers in Tabriz-Iran in 2013. The participants were allocated to three 42 member groups using a randomized block design. For 42 days, the intervention groups took a 1000 unit Vitamin D pill or 300 mg calcium carbonate plus a 1000 unit Vitamin D pill, and the control group received a placebo pill every day. The participants were evaluated with regard to the frequency, length, and pain intensity of leg cramps during the week before and during the 3rd and 6th week of the intervention. The ANCOVA and repeated measurement test were used to analyze the data. Results Results showed that controlling for the effects before the intervention, calcium-Vitamin D, and Vitamin D supplements had no effect on the frequency, length, and pain intensity of leg cramps. Conclusion The results of this study showed that the calcium-Vitamin D and the Vitamin D supplements have no effect on the frequency, length, and pain intensity of leg cramps during the 6 weeks of the study.
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Background: Evidence indicates that sleep may be affected by using vitamins and minerals or lack of them. This study aimed to determine the effects of vitamin D and calcium-vitamin D in the treatment of sleep disorders in pregnant women with leg cramps. Methods: This triple-blind randomized controlled clinical trial took place on 126 pregnant women referred to Tabriz health centers, Tabriz, Iran, in 2013-2014. Subjects were allocated in to three groups, using block randomization. The groups received vitamin D, calcium-vitamin D and placebo pills daily for 60 days. Sleep score was measured before and after the intervention, using the Pittsburgh Sleep Quality Index. ANCOVA test was used for data analysis. Findings: Controlling baseline score before the intervention, there was no significant differences in the sleep quality score after intervention between the group receiving calcium-vitamin D and the control group (adjusted difference: -0.3, 95% confidence interval: -1.4 to 2.1), the group receiving vitamin D and controls (adjusted difference: -0.007, 95% confidence interval: -1.7 to 1.7) and between the two groups receiving calcium-vitamin D and vitamin D (adjusted difference: -0.3, 95% confidence interval: -1.4 to 2.1). Also, there was no significant difference between the groups in sleep quality subscales (P > 0.05). Conclusion: The results show that calcium-vitamin D and vitamin D does not effect on improving the sleep quality in pregnant women with leg cramps.
Article
Background: Leg cramps are a common problem in pregnancy. Various interventions have been used to treat them, including drug, electrolyte and vitamin therapies, and non-drug therapies. Objectives: To assess the effectiveness and safety of different interventions for treating leg cramps in pregnancy. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Register (31 March 2015) and reference lists of retrieved studies. Selection criteria: Randomised controlled trials (RCTs) of any intervention (drug, electrolyte, vitamin or non-drug therapies) for treatment of leg cramps in pregnancy compared with placebo, no treatment or other treatment. Quinine was excluded for its known adverse effects (teratogenicity). Cluster-RCTS were considered for inclusion. Quasi-RCTs and cross-over studies were excluded. Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Main results: We included six studies (390 women). Four trials compared oral magnesium with placebo/no treatment, two compared oral calcium with no treatment, one compared oral vitamin B versus no treatment, and one compared oral calcium with oral vitamin C. Two of the trials were well-conducted and reported, the other four had design limitations. The process of random allocation was sub-optimal in three studies, and blinding was not attempted in two. Outcomes were reported in different ways, precluding the use of meta-analysis and limiting the strength of our conclusions.The 'no treatment' group in one four-arm trial has been used as the comparison group for the composite outcome (intensity and frequency of leg cramps) in magnesium, calcium, and vitamin B versus no treatment. This gives it disproportionate weight in the overall analysis, thus interpretation of these results should be cautious. Oral magnesium versus placebo/no treatmentMagnesium (taken orally for two to four weeks) did not consistently reduce the frequency of leg cramps compared with placebo or no treatment. Outcomes that showed differences were: frequency of leg cramps after treatment: never, and twice a week (risk ratio (RR) 5.66, 95% confidence interval (CI) 1.35 to 23.68, one trial, 69 women, evidence graded low; RR 0.29, 95% CI 0.11 to 0.80, one trial, 69 women), and frequency of leg cramps: 50% reduction in number of leg cramps after treatment (RR 1.42, 95% CI 1.09 to 1.86, one trial, 86 women, evidence graded low). The outcomes that showed no difference were: frequency of leg cramps during two weeks of treatment (mean difference (MD) 1.80, 95% CI -1.32 to 4.92, one trial, 38 women, evidence graded low); frequency of leg cramps after treatment: daily, every other day, and once a week (RR 1.20, 95% CI 0.45 to 3.21, one trial, 69 women; RR 0.44, 95% CI 0.12 to 1.57, one trial, 69 women; RR 1.54, 95% CI 0.62 to 3.87, one trial, 69 women).Evidence about whether magnesium supplements reduced the intensity of pain was inconclusive, with two studies showing that it may slightly reduce pain, while one showed no difference. There were no differences in the experience of side effects (including nausea, flatulence, diarrhoea and intestinal air) between pregnant women receiving magnesium compared with placebo/no treatment. Oral calcium versus no treatmentA greater proportion of women receiving calcium supplements experienced no leg cramps after treatment than those receiving no treatment (frequency of leg cramps after treatment: never RR 8.59, 95% CI 1.19 to 62.07, one study, 43 women, evidence graded very low). There was no difference between groups for a composite outcome (intensity and frequency) for partial improvement (RR 0.64, 95% CI 0.36 to 1.15, one trial, 42 women); however, the same trial showed a greater proportion of women experiencing no leg cramps after treatment with calcium compared with no treatment (RR 5.50, 95% CI 1.38 to 21.86).Other secondary outcomes, including side effects, were not reported. Oral vitamin B versus no treatment Frequency of leg cramps was not reported in the one included trial. According to a composite outcome (frequency and intensity), more women receiving vitamin B fully recovered compared with those receiving no treatment (RR 7.50, 95% CI 1.95 to 28.81). Those women receiving no treatment were more likely to experience a partial improvement in the intensity and frequency of leg cramps than those taking vitamin B (RR 0.29, 95% CI 0.11 to 0.73, one trial, 42 women), or to see no change in their condition. However, these results are based on one small study with design limitations.Other secondary outcomes, including side effects, were not reported. Oral calcium versus oral vitamin CThere was no difference in the frequency of leg cramps after treatment with calcium versus vitamin C (RR 1.33, 95% CI 0.53 to 3.38, one study, 60 women, evidence graded very low). Other outcomes, includingside effects, were not reported. Authors' conclusions: It is unclear from the evidence reviewed whether any of the interventions (oral magnesium, oral calcium, oral vitamin B or oral vitamin C) provide an effective treatment for leg cramps. This is primarily due to outcomes being measured and reported in different, incomparable ways, and design limitations compromising the quality of the evidence (the level of evidence was graded low or very low). This was mainly due to poor study design and trials being too small to address the question satisfactorily.Adverse outcomes were not reported, other than side effects for magnesium versus placebo/no treatment. It is therefore not possible to assess the safety of these interventions.The inconsistency in the measurement and reporting of outcomes, meant that data could not be pooled, meta-analyses could not be carried out, and comparisons between studies are difficult.The review only identified trials of oral interventions (magnesium, calcium, vitamin B or vitamin C) to treat leg cramps in pregnancy. None of the trials considered non-drug therapies, for example, muscle stretching, massage, relaxation, heat therapy, and dorsiflexion of the foot. This limits the completeness and applicability of the evidence.Standardised measures for assessing the frequency, intensity and duration of leg cramps to be used in large well-conducted randomised controlled trials are needed to answer this question. Trials of non-drug therapies are also needed.
Article
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Calf cramps are sudden, involuntary, painful contractions of part of or the entire calf muscle that are visible, persist for seconds to minutes and then spontaneously resolve. They can occur with no identifiable cause, and are then referred to as common calf cramps. They may also be symptoms associated with diseases of the peripheral and central nervous system and muscle diseases. They also occur in association with metabolic disorders. In such cases the cramps are more extensive, intense and persist for longer. Cramp-fasciculation-myalgia syndrome additionally involves paresthesias and other signs of hyperexcitability of peripheral nerves. The recommended treatment for patients with frequent calf cramps causing significant impairment of well-being is oral administration of quinidine and/or botulinum toxin treatment of the calf muscles. During pregnancy both products are contraindicated, while probatory administration of magnesium is indicated.
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Our aim was to assess the effect of 360mg magnesium oral substitution daily among pregnant women suffering from leg cramps in pregnancy, defined as painful cramps different from restless legs symptoms. In a double blind randomised controlled trial healthy pregnant women between 18 and 36 weeks of pregnancy suffering from painful leg cramps, at least twice a week, were invited to participate. Forty-five women were enrolled initially, 38 completed the treatment and were treated during 2 weeks with either magnesium (360mg=15mmol magnesium lactate and magnesium citrate, Nycoplus Magnesium), or placebo tablets. Serum magnesium and calcium were investigated together with urine magnesium and magnesium-creatinin ratio on day 1 and day 15. Frequency and intensity of leg cramps were recorded. The study was powered to detect a 50% reduction in leg cramps. Registration of pain frequency and intensity during the two study weeks demonstrated no significant differences between the two groups. Mean number and intensity of cramps were 9.5 (S.D. 5.1) and 13.2 (S.D. 6.5) in the magnesium group, compared to 7.7 (S.D. 4.7) and 11.4 (S.D. 8.5) in the placebo group. Baseline magnesium levels were 0.77 and 0.74mmol/L in the magnesium group and the placebo group, respectively No significant differences between the two groups, or within the groups, were found when comparing serum values of serum magnesium and total calcium at inclusion time and at the end of the treatment. There was a statistically significant increase in magnesium excretion in the magnesium treatment group (p<0.01). The number of dropouts was two in the treatment group and five in the control group. No significant effect on frequency or intensity of leg cramps in pregnant women of magnesium treatment with 360mg daily could be detected in this trial.
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Sleep disturbance during pregnancy can result in excessive daytime sleepiness, diminished daytime performance, inability to concentrate, irritability, and the potential for an increased length of labor and increased risk of operative birth. Sleep disturbance may be the result of a sleep disorder, such as leg cramps, a common yet benign disorder, or restless legs syndrome, a sensorimotor disorder. Both disrupt sleep, are distressing to the pregnant woman, and mimic one another and other serious disorders. During pregnancy, up to 30% of women can be affected by leg cramps, and up to 26% can be affected by restless legs syndrome.
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