Clinical ReviewPrevalence of restless legs syndrome during pregnancy: A systematic review and meta-analysis
Introduction
Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a neurological disorder that causes a desire to move the legs because of unpleasant feelings [1]. It is closely associated with numerous diseases, including kidney disease, cardiovascular disease, and Parkinson's disease [2]. The prevalence of RLS in the general population is 2–10% [3], and women are affected twice as often as men [4]. Furthermore, the prevalence of RLS in nulliparous women is comparable to men [3], and pregnant women are more likely to have RLS [5], indicating that pregnancy per se is a significant risk factor for RLS.
Pregnancy-related RLS has been associated with several pregnancy complications, including hypertension [6], cardiovascular disease [7], and preeclampsia [8]. Moreover, RLS in pregnancy also adversely influences neonatal outcomes, such as preterm birth [9], [10]. However, RLS is often unrecognized by patients and doctors in clinical practice [11]. To set priorities for public health policy, fund public health initiatives, and develop healthcare planning, the prevalence of RLS during pregnancy needs to be determined. Several studies from different countries have reported the prevalence of RLS among pregnant women, but information on the worldwide and regional prevalence of RLS is lacking. Moreover, the prevalence of RLS in different phases of pregnancy and regions may vary. Most studies on the association between pregnancy trimesters and RLS reported an increase in the prevalence of RLS in the third trimester ∗[12], ∗[13], ∗[14], ∗[15], [16], ∗[17], [18], [19], [20]. The present study evaluated the worldwide and regional prevalence of RLS in pregnancy according to the broad World health organization (WHO) regional classification and its association with pregnancy trimesters using a meta-analytic strategy.
Section snippets
Search strategy and selection criteria
We performed a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines [21]. A systematic search of the PubMed, Medline, EMBASE, and Web of Science databases was performed to identify studies that were published up to April 2017 that reported the prevalence of RLS during pregnancy. The following grouped terms were searched by title, abstract, or keyword: (pregnancy OR pregnant OR gravidity OR gestation) AND (restless
Literature search
A total of 196 papers were retrieved (Fig. 1), among which 33 studies evaluated the prevalence of RLS during pregnancy. An early investigation conducted by Jolivet et al. reported the prevalence of RLS in pregnancy but was not included in these 33 studies because it was not published in English [32]. Of these 33 articles, six that reported RLS rates during pregnancy were excluded from further analysis because two of them did not specify the number of women who had RLS during pregnancy [33], [34]
Discussion
To better understand the relationship between pregnancy and RLS, the present study used a meta-analytic strategy to assess the worldwide and regional prevalence of RLS during pregnancy according to the broad WHO regional classification. We found that the overall pooled prevalence of RLS in pregnant women was 21%, and the prevalence of RLS in different regions varied. Compared with the European Region, Eastern Mediterranean Region, and Region of the Americas, the rate of RLS during pregnancy in
Conclusions
In conclusion, the overall prevalence of RLS in pregnancy was as high as 21% and two- to ten-fold higher than in the general population. Regional differences were found in the prevalence of obstetric RLS, which was lower in the Western Pacific Region than in the European Region, Eastern Mediterranean Region, and Region of the Americas. As trimesters progressed, the prevalence of RLS during pregnancy increased and reached a peak in the third trimester. Iron deficiency, hormonal changes, and
Authors' contributions
L Shi, MV Vitiello, YQ Wang, and L Lu proposed the topic of the meta-analysis. SJ Chen and L Shi performed the literature search, extracted and selected articles, performed the primary analysis, and wrote the paper. YP Bao, YK Sun, YX Zhou, X Lin, and JY Que checked the data and commented on and revised the manuscript. MV Vitiello commented on and revised the manuscript.
Conflicts of interest
The authors do not have any conflicts of interest to declare.
Acknowledgments
This work was supported by the National Basic Research Program of China (no. 2015CB856400), Beijing Municipal Science and Technology Commission (no. Z151100003915121 and Z151100003915117), and Natural Science Foundation of China (no. 81521063). The authors thank Dr Ying Han for reading the manuscript.
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These authors contributed equally to this work.
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