Elsevier

Sleep Medicine Reviews

Volume 40, August 2018, Pages 43-54
Sleep Medicine Reviews

Clinical Review
Prevalence of restless legs syndrome during pregnancy: A systematic review and meta-analysis

https://doi.org/10.1016/j.smrv.2017.10.003Get rights and content

Summary

Pregnant women are more likely to be affected by restless legs syndrome (RLS) than the general population. Restless legs syndrome during pregnancy is associated with adverse maternal and fetal outcomes. Currently unknown is the worldwide and regional prevalence of RLS in pregnant women. We performed a meta-analysis to provide a full profile of the prevalence of RLS during pregnancy. 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, followed by random-effects meta-analyses. A total of 196 articles were identified, among which 27 longitudinal and cross-sectional observational studies with 51,717 pregnant subjects were included in the analysis. The pooled overall prevalence of RLS across all three trimesters was 21%. According to the regional classification of the World health organization, the prevalence of RLS during pregnancy in the European Region, Western Pacific Region, Eastern Mediterranean Region, and Region of the Americas was 22%, 14%, 30%, and 20%, respectively. The regional prevalence in the African Region and South-East Asia Region was not assessed because of insufficient data. We also analyzed the prevalence of RLS in the first, second, and third trimesters of pregnancy, and the rates of RLS were 8%, 16%, and 22%, respectively. We also found that the high prevalence of RLS decreased to 4% after delivery. No publication bias was found in these analyses. The findings emphasize the high occurrence of RLS during pregnancy. Future studies should examine the effects of RLS during pregnancy on maternal and fetal outcomes.

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.

References (64)

  • R. Sikandar et al.

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

    Sleep Med

    (2009)
  • J.A. Mindell et al.

    Sleep patterns and sleep disturbances across pregnancy

    Sleep Med

    (2015)
  • R.P. Allen et al.

    Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria – history, rationale, description, and significance

    Sleep Med

    (2014)
  • C.M. Shaw-Bruha et al.

    17 beta-Estradiol inhibits the production of dopamine by the tuberoinfundibular dopaminergic neurons of the male rat

    Brain Res Bull

    (1996)
  • D.L. Picchietti et al.

    Consensus clinical practice guidelines for the diagnosis and treatment of restless legs syndrome/Willis-Ekbom disease during pregnancy and lactation

    Sleep Med Rev

    (2015)
  • M.M. Ohayon et al.

    Epidemiology of restless legs syndrome: a synthesis of the literature

    Sleep Med Rev

    (2012)
  • N.G. Kutner et al.

    Restless legs complaint in African-American and Caucasian hemodialysis patients

    Sleep Med

    (2002)
  • C. Trenkwalder et al.

    Restless legs syndrome associated with major diseases: a systematic review and new concept

    Neurology

    (2016)
  • R.P. Allen et al.

    Restless legs syndrome prevalence and impact: REST general population study

    Arch Intern Med

    (2005)
  • K. Berger et al.

    Sex and the risk of restless legs syndrome in the general population

    Arch Intern Med

    (2004)
  • S. Ma et al.

    Restless legs syndrome and hypertension in Chinese pregnant women

    Neurol Sci

    (2015)
  • Z. Meharaban et al.

    Restless legs syndrome during pregnancy and preterm birth in women referred to health centers of Ardabil

    Iran Red Crescent Med J

    (2015)
  • M. Minar et al.

    Prevalence and impact of restless legs syndrome in pregnancy

    Neuroendocrinol Lett

    (2013)
  • K. Suzuki et al.

    The prevalence of restless legs syndrome among pregnant women in Japan and the relationship between restless legs syndrome and sleep problems

    Sleep

    (2003)
  • M. Manconi et al.

    Restless legs syndrome and pregnancy

    Neurology

    (2004)
  • S. Harano et al.

    Prevalence of restless legs syndrome with pregnancy and the relationship with sleep disorders in the Japanese large population

    Sleep Biol Rhythm

    (2008)
  • J.P. Neau et al.

    Restless legs syndrome and pregnancy: a questionnaire study in the Poitiers District, France

    Eur Neurol

    (2010)
  • X. Shang et al.

    Restless legs syndrome among pregnant women in China: prevalence and risk factors

    Sleep Breath

    (2015)
  • K.A. Lee et al.

    Restless legs syndrome and sleep disturbance during pregnancy: the role of folate and iron

    J Womens Health Gend Based Med

    (2001)
  • S. Plancoulaine et al.

    Sleep trajectories among pregnant women and the impact on outcomes: a population-based cohort study

    Matern Child Health J

    (2017)
  • F.L. Facco et al.

    Sleep disturbances in pregnancy

    Obstet Gynecol

    (2010)
  • D. Moher et al.

    Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

    PLoS Med

    (2009)
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