A Neglected Area: Restless Leg Syndrome in Pregnancy and The Role of the Obstetric and Gynecology Nurse

Year 2023, , 1073 - 1080, 08.10.2023

Özlem Kaplan , Mürüvvet Başer

https://doi.org/10.61399/ikcusbfd.1161636

Cited By: 1

Abstract

Restless legs syndrome is the most common movement disorder in pregnancy and is more common in pregnant women than in healthy women and men. However, it is not well known among obstetricians. Similarly, the awareness of pregnant women about restless legs syndrome is also low. Genetics, the brain’s dopamine system and iron metabolism are thought to be effective in the pathophysiology of the disease in pregnancy. The disease usually disappears after delivery, but if not treated, sleep disorders, psychological problems, decreased quality of life, as well as symptoms of pregnancy and birth-related complications such as preeclampsia, the threat of miscarriage, premature birth, difficult birth, cesarean delivery and intrauterine growth retardation may occur. Diagnosis in pregnancy is made using the basic criteria of the International Restless Legs Syndrome Working Group. Non-pharmacological methods are primarily recommended for treatment. However, if symptoms are severe, more reliable drugs should be considered. In symptom management, it is essential to control anemia, sleep apnoea, and drug use that exacerbate restless legs syndrome. To reduce the severity of restless legs syndrome during pregnancy, non-pharmacological treatments such as moderate exercise, yoga, hot/cold water applications, relaxation exercise, relaxing background music, and sleep hygiene can be recommended. Obstetrics and gynecology nurses, who have a crucial role and responsibility in pregnancy follow-up, should be able to provide effective and quality care to women in the prepartum, peripartum, intrapartum, and postpartum periods with a comprehensive approach in line with evidence-based practices.

Keywords

Pregnancy, restless legs syndrome, obstetrics and gynecology nursing, nursing care.

İhmal Edilen Bir Alan: Gebelikte Huzursuz Bacak Sendromu ve Kadın Sağlığı Hemşiresinin Rolü

Abstract

Huzursuz bacak sendromu gebelikte en fazla görülen hareket bozukluğu olup gebelerde sağlıklı kadınlara ve erkeklere göre daha sık görülmektedir. Buna karşın doğum uzmanları tarafından yeterince tanınmamaktadır. Benzer şekilde gebelerin de huzursuz bacak sendromuna ilişkin farkındalıkları düşüktür. Hastalığın gebelikteki patofizyolojisinde genetik, beyin dopamin sistemi ve demir metabolizmasının etkili olduğu düşünülmektedir. Semptomlar genellikle doğumdan sonra kaybolmaktadır ancak hastalık tedavi edilmezse uyku bozukluğu, psikolojik sorunlar, yaşam kalitesinde azalmanın yanında preeklampsi, düşük tehdidi, erken doğum, zor doğum, sezeryan doğum ve intrauterin büyüme geriliği gibi gebelik ve doğumla ilgili komplikasyonlar yaşanabilmektedir. Gebelikte tanı, Uluslararası Huzursuz Bacak Sendromu Çalışma Grubu'nun temel kriterleri kullanılarak konulmaktadır. Tedavide primer olarak non-farmakolojik yöntemler önerilmektedir. Ancak semptomlar şiddetli ise daha güvenilir olan ilaçlar düşünülmelidir. Semptom yönetiminde öncelikle anemi, uyku apnesi, huzursuz bacak sendromunu şiddetlendiren ilaç kullanımı gibi faktörlerin kontrol altına alınması önemlidir. Gebelikte huzursuz bacak sendromu şiddetini azaltmaya yönelik orta derecede egzersiz, yoga, sıcak/soğuk su uygulamaları, progresif gevşeme egzersizi, gevşeme fon müziği dinlenmesi, uyku hijyeni gibi farmakolojik olmayan tedaviler önerilebilmektedir. Gebe takibinde önemli rol ve sorumluluğu olan kadın sağlığı hemşirelerinin kadınlara prepartum, peripartum, intrapartum ve postpartum dönemde bütüncül bir yaklaşımla kanıta dayalı uygulamalar doğrultusunda etkili ve kaliteli bir bakım verebilmesi gerekmektedir.

Keywords

Gebelik, huzursuz bacak sendromu, kadın hastalıkları ve doğum hemşireliği, hemşirelik bakımı

References

• Almeneessie AS, Alyousefi N, Alzahrani M, Alsafi A, Alotaibi R, OlaishH., et al. Prevalence of restless legs syndrome among pregnant women: a case-control study. Ann Thorac Med [Internet]. 2020 Jan [cited 2022May 22];15(1): 9-14. DOI: 10.4103/atm.ATM_206_19
• Abdi A, Hussein Shareef O, Dalvand S, GhaneiGheshlagh R, HasanpourDehkordi A. Prevalence of restless legs syndrome in pregnant women: a systematic review and meta-analysis. PrzeglEpidemiol[Internet]. 2021 Apr [cited 2022May 22]; 75(3):402-12. Available from: http://eprints.skums.ac.ir/9499/ DOI: 10.32394/pe.75.37
• Steinweg K, Nippita T, Cistulli PA, Bin YS. Maternal and neonatal outcomes associated with restless legs syndrome in pregnancy: a systematic review. Sleep Med Rev[Internet]. 2020 Dec [cited 2022May 22]; 54: 101359. Available from: https://www.sciencedirect.com/ science/article/pii/S1087079220301027?casa_token=gcYITTFqWLMAA AAA:szVDy45ZHizSDQKn8nrvfr0ybPNFPd0WuysWrHr6Y6Z6nAe0MBjC Xh-pRsSmU25IKac83lC4rXEDOI: 10.1016/j.smrv.2020.101359
• Prosperetti C, Manconi M. Restless legs syndrome/Willis-Ekbom disease and pregnancy. Sleep Med Clin[Internet]. 2015Sep[cited 2022 May 22]; 10(3): 323-9. Available from: https://www.sleep.theclinics.com/ article/S1556-407X(15)00051-X/fulltext DOI: 10.1016/j.jsmc.2015.05.016
• Budhiraja P, Budhiraja R, Goodwin JL, Allen RP, Newman AB, Koo BB, et al. Incidence of restless legs syndrome and its correlates. JCSM [Internet]. 2012Apr[cited 2022 May 22]; 8(2): 119-24. Available from: https://jcsm. aasm.org/doi/full/10.5664/jcsm.1756 DOI: 10.5664/jcsm.1756
• Dzaja A, Wehrle R, Lancel M, Pollmächer T. Elevated estradiol plasma levels in women with restless legs during pregnancy. Sleep[Internet]. 2009Feb[cited 2022 May 22]; 32(2): 169-74. Available from: https:// academic.oup.com/sleep/article/32/2/169/2454313 DOI: 10.5665/ sleep/32.2.169
• Cui X, Pelekanos M, Liu PY, Burne THJ, McGrath JJ, Eyles DW. The vitamin D receptor in dopamine neurons; its presence in human substantia nigra and its ontogenesis in rat midbrain. Neuroscience[Internet]. 2013 Apr [cited 2022 May 22]; 236: 77-87. Available from: https://www. sciencedirect.com/science/article/pii/S0306452213000729?casa_tok en=CR1xPphtHn4AAAAA:CoNWLOLqrwKuoE1UyGRzUCuaVIYElKN4 kDYvHpJh6BXiIVFXSwZW61hE2RXeXVivLNZcz-wI-EQ DOI: 10.1016/j. neuroscience.2013.01.035
• Lee KA, Zaffke ME, Baratte-Beebe K. Restless legs syndrome and sleep disturbance during pregnancy: the role of folate and iron. J. Womens Health Gend Based Med [Internet]. 2004 Jul[cited 2022 May 22]; 10(4): 335-41. Available from: https://www. liebertpub.com/doi/abs/10.1089/152460901750269652?casa_ token=NCEQnDi4ig0AAAAA:OoninY2Ddnm_tH0Z67QZx7DPjttDvb BTOtIANEyzcHktOhZPB-iTZbLoCBEgcwGIlUNTMoD3M3GrczIUDOI: 10.1089/152460901750269652
• Salminen AV, Lam DD, Winkelmann J. Role of MEIS1 in restless legs syndrome: from GWAS to functional studies in mice. AdvPharmacol[Internet]. 2019Apr[cited 2022 May 22]; 84: 175-84. Available from: https://www.sciencedirect.com/science/article/abs/pii/ S105435891930016XDOI: 10.1016/bs.apha.2019.03.003
• Meneely S, Dinkins ML, Kassai M, Lyu S, Liu Y, Lin CT, et al. Differential dopamine D1 and D3 receptor modulation and expression in the spinal cord of two mouse models of restless legs syndrome. Front BehavNeurosci[Internet]. 2018Sep[cited 2022 May 22]; 12: 199. Available from: https://www.frontiersin.org/articles/10.3389/fnbeh.2018.00199/ full. DOI: 10.3389/fnbeh.2018.00199
• Cesnik E, Casetta I, Turri M, Govoni V, Granieri E, Strambi LF, et al. Transient RLS during pregnancy is a risk factor for the chronic idiopathic form. Neurology[Internet]. 2010 Dec[cited 2022 May 22]; 75(23): 2117- 20. Available from: https://n.neurology.org/content/75/23/2117.short. DOI: 10.1212/WNL.0b013e318200d779
• Allen RP, PicchiettiDL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, 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 [Internet]. 2014Aug [cited 2022 May 22]; 15(8): 860-73.
• Djokanovic N, Garcia-Bournissen F, Koren G. Medications for restless legs syndrome in pregnancy. J ObstetGynaecol Can. 2008;30:505-507. Available from: https://www.jogc.com/article/S1701-2163(16)32866-3/ pdf
• Picchietti DL, Wang VC, Picchietti MA. Intravenous iron given prior to pregnancy for restless legs syndrome is associated with remission of symptoms. J Clin Sleep Med 2012;8:585e6. Available from: https://jcsm. aasm.org/doi/full/10.5664/jcsm.2168 DOI:10.5664/jcsm.2168
• Schneider J, Krafft A, Manconi M, et al. Open-label study of the efficacy and safety of intravenous ferric carboxymaltose in pregnant women with restless legs syndrome. Sleep Med. 2015;16:1342-1347. Available from: https://www.sciencedirect.com/science/article/pii/ S1389945715008989 DOI:10.1016/j.sleep.2015.08.006
• Cho YW, Allen RP, Earley CJ. Lower molecular weight intravenous iron dextran for restless legs syndrome. Sleep Med. 2013;14:274-277. Available from: https://www.sciencedirect.com/science/article/pii/ S1389945712004005 DOI:10.1016/j.sleep.2012.11.001
• Vadasz D, Ries V, Oertel WH. Intravenous iron sucrose for restless legs syndrome in pregnant women with low serum ferritin. Sleep Med. 2013;14:1214-1216. Available from: https://www.sciencedirect. com/science/article/pii/S1389945713002293 DOI:10.1016/j. sleep.2013.05.018
• Picchietti DL, Hensley JG, Bainbridge JL, Lee KA, Manconi M, McGregor JA, 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[Internet]. 2015Aug[cited 2022 May 22]; 22: 64-77. Available from: https://www. sciencedirect.com/science/article/pii/S1087079214001191?casa_tok en=Jk9074eVTjEAAAAA:bOzySMtogZjastMod0D1w7P22FjxFa9qAG mx5lBmAlNzMjW6-2n1uu5wogY33WPivH_eobI2bM8DOI: 10.1016/j. smrv.2014.10.009
• Trenkwalder C, Paulus W. Restless legs syndrome: pathophysiology, clinical presentation and management. Nature Reviews Neurolog[Internet]. 2010 Jun[cited 2022 May 22]; 6(6): 337-46. Available from: https://www.nature.com/articles/nrneurol.2010.55DOI: 10.1038/ nrneurol.2010.55
• Garcia-Borreguero D, Kohnen R, Silber MH, Winkelman JW, Earley CJ, Högl B.et al. The long-term treatment of restless legs syndrome/ Willis-Ekbom disease: Evidence-based guidelines and clinical consensus best practice guidance: a report from the International Restless Legs Syndrome Study Group. SleepMed[Internet]. 2013 Jul[cited 2022 May 22]; 14: 675–84. Available from: https://www.sciencedirect.com/science/ article/pii/S1389945713002116 DOI: 10.1016/j.sleep.2013.05.016
• Hurault-Delarue C, Montastruc JL, Beau AB, Lacroix I, Damase-Michel C. Pregnancy outcome in women exposed to dopamine agonists during pregnancy: a pharmacoepidemiology study in EFEMERIS database. Arch GynecolObstet[Internet]. 2014Mar[cited 2022 May 22]; 290(2): 263-70. Available from: https://link.springer.com/article/10.1007/s00404-014- 3210-z DOI: 10.1007/s00404-014-3210-z
• Whiteman VE, Salemi JL, Mogos MF, Cain MA, Aliyu MH, Salihu HM. Maternal opioid drug use during pregnancy and its impact on perinatal morbidity, mortality, and the costs of medical care in the United States. J Pregnancy [Internet]. 2014 Aug[cited 2022 May 22]; 2014. Available from: https://www.hindawi.com/journals/jp/2014/906723/ DOI: 10.1155/2014/906723
• Sönmez A, AksoyDerya Y. Effects of sleep hygiene training given to pregnant women with restless leg syndrome on their sleep quality. Sleep Breath[Internet]. 2018 Jan [cited 2022 May 22]; 22(2): 527-35. Available from: https://link.springer.com/article/10.1007/s11325-018- 1619-5 DOI: 10.1007/s11325-018-1619-5
• Kaplan Ö, Başer M.Huzursuz bacak sendromu olan gebelerde sıcak su uygulamasının etkisi: randomize kontrollü çalışma. 6 International GevherNesibe Health Sciences Conference, [Internet]. 2020 Nov [cited 2022 May 22]; 5-6. Available from: https://6e9ed515-8cbf-4760-8640-9a7779db5794.filesusr.com/ ugd/614b1f_84a6bd676e2f45f1b414856cccaa54ff.pdf
• Kaplan Ö. The effect of hot and cold water application to pregnant women with restless leg syndrome on complaints and quality of sleep [dissertation on the internet]. Türkiye (TR): University of Erciyes; 2022. [cited 2023 Feb 20]; Available from: https://tez.yok.gov.tr/ UlusalTezMerkezi/tezSorguSonucYeni.jsp
• Yüksel E.Effects of progressive relaxation exercises on restless legs syndrome severity and sleep quality in pregnant women [dissertation on the internet].Türkiye (TR): University of Ege; 2017. [cited 2022 May 22]; Available from: https://tez.yok.gov.tr/UlusalTezMerkezi/ tezSorguSonucYeni.jsp
• Silber MH, Ehrenberg BL, Allen RP, Buchfuhrer MJ, Earley CJ, Hening WA, et al. An algorithm for the management of restless legs syndrome. Mayo Clin Proc [Internet]. 2004Jul[cited 2022 May 22]; 79(7): 916-922. Available from: https://www.sciencedirect.com/science/article/abs/ pii/S0025619611621605 DOI: 10.4065/79.7.916
• Aukerman MM, Aukerman D, Bayard M, Tudiver F, Thorp L, Bailey B. Exercise and restless legs syndrome: a randomized controlled trial. JABFM [Internet]. 2006 Sep [cited 2022 May 22]; 19(5): 487-93. Available from: https://www.jabfm.org/content/19/5/487.short/ DOI: 10.3122/jabfm.19.5.487
• Lettieri CJ, Eliasson AH. Pneumatic compression devices are an effective therapy for restless legs syndrome: a prospective, randomized, double-blinded, sham-controlled trial. Chest[Internet]. 2009 Jan [cited 2022 May 22]; 135(1): 74-80. Available from: https:// www.sciencedirect.com/science/article/abs/pii/S0012369209600696 DOI: 10.1370/chest.08-1665
• Mitchell UH. Nondrug-related aspect of treating Ekbom disease, formerly known as restless legs syndrome. Neuropsychiatr Dis Treat [Internet]. 2011 Jan [cited 2022 May 22]; 7: 251. Available from: https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC3101885/ DOI: 10.2147/NDT. S19177
• Minár M, Habánová H, Rusnak I, Planck K, Valkovic P. Prevalence and impact of restless legs syndrome in pregnancy. Neuroendocrinol Lett[Internet]. 2013Aug[cited 2022 May 22]; 34(5): 366-71. Available from: http://nel.altamira.sk/userfiles/articlesnew/NEL340513A07.pdf
• Ramirez JO, Cabrera SAS, Hidalgo H, Cabrera SG, Linnebank M, BassettiCL, Kallweit U. Is preeclampsia associated with restless legs syndrome?. Sleep Med[Internet]. 2013Sep[cited 2022 May 22]; 14(9): 894-6. Available from: https://pubmed.ncbi.nlm.nih.gov/23891236/ DOI: 0.1016/j.sleep.2013.03.013
• Wesström J, Skalkidou A, Manconi M, Fulda S, Sundström-Poromaa I. Pre-pregnancy restless legs syndrome (Willis-Ekbom Disease) is associated with perinatal depression. JCSM [Internet]. 2014May[cited 2022 May 22]; 10(5): 527-33. Available from: https://jcsm.aasm.org/doi/ full/10.5664/jcsm.3704 DOI: 10.5664/jcsm.3704
• Vahdat M, Sariri E, Miri S, Rohani M, Kashanian M, Sabet A, et al. Prevalence and associated features of restless legs syndrome in a population of Iranian women during pregnancy. Int J GynaecolObstet[Internet]. 2013Oct[cited 2022 May 22]; 123(1): 46-9. Available from: https://www.sciencedirect.com/science/article/abs/ pii/S0020729213003263/ DOI: 10.1016/j.ijgo.2013.04.023
• Chełminiak Ł, Siemiński M, Skrzypek-Czerko M, Roszmann A. Restless legs syndrome in nursing practice. JNNN [Internet]. 2018 Jan [cited 2022 May 22]; 7(4): 166-72. Available from: https://apcz.umk.pl/ PNIN/article/view/38147 DOI: 10.15225/PNN.2018.7.4.6
• Neyal A, Senel GB, Aslan R,Nalbantoglu M, Acikgoz S, Yilmaz N, et al. A prospective study of Willis–Ekbom disease/restless legs syndrome during and after pregnancy. Sleep Med[Internet]. 2015Sep[cited 2022 May 22]; 16(9): 1036-40. Available from: https://www.sciencedirect. com/science/article/pii/S1389945715007376. DOI: 10.1016/j. sleep.2015.01.026
• Resmi Gazete. Hemşirelik Yönetmeliği. Sayı: 27515. [Internet]. 2010 Apr [cited 2023 Feb 20]; 7: 251. Available from: chrome-extension:// efaidnbmnnnibpcajpcglclefindmkaj/https://nphemsirelik.com/assets/ uploads/file/NPistanbul-hemsirelik-yasasi.pdf