Gebelikte Huzursuz Bacak Sendromu

Yıl 2023, Cilt: 5 Sayı: 1, 88 - 102, 25.04.2023

Özlem Kaplan , Mürüvvet Başer

Öz

Huzursuz bacak sendromu (HBS) gebelikte en fazla görülen hareket bozukluğu olup gebelerde sağlıklı kadınlara ve erkeklere göre daha sık görülmektedir. Özellikle üçüncü trimesterde olmak üzere gebelerin %21.4’ünü etkilemektedir. Hastalığın gebelikteki patofizyolojisinde genetik, beyin dopamin sistemi ve demir metabolizmasının etkili olduğu düşünülmektedir. Tedavi edilmezse uyku bozukluğu, psikolojik sorunlar, yaşam kalitesinde azalma, preeklampsi, düşük tehdidi, erken doğum, zor doğum, sezeryan doğum ve intrauterin büyüme geriliği gibi komplikasyonlar yaşanabilen hastalığın semptomları genellikle doğumdan sonra kaybolmaktadır.
Hastalığın tanısı Uluslararası Huzursuz Bacak Sendromu Çalışma Grubu'nun temel kriterleri kullanılarak konulmaktadır. Sendromun en önemli birinci basamak tedavisi, gebelikte çok yaygın görülen demir eksikliğini gidermek için yapılan demir takviyesidir. Ancak semptomlar şiddetli ise tedavide güvenilir olan ilaçların kullanılması gerekebilmektedir ancak primer olarak non-farmakolojik yöntemler önerilmektedir. İkinci yaklaşım özellikle gebelikte davranışsal ve farmakolojik olmayan tedavilerin kullanımı olmalıdır. HBS’nin semptom yönetiminde anemi, uyku apnesi, HBS'yi şiddetlendiren ilaç kullanımı gibi faktörlerin kontrol altına alınmasının yanı sıra; orta derecede egzersiz, yoga, sıcak/soğuk su uygulamaları, progresif gevşeme egzersizleri ve uyku hijyeni gibi uygulamaların yapılması önerilmektedir.

Anahtar Kelimeler

Gebelik, Huzursuz bacak sendromu, Tedavi.

Destekleyen Kurum

Destekleyen bir kurum bulunmamaktadır.

Restless Legs Syndrome in Pregnancy

Öz

Restless legs syndrome (RLS) is the most common movement disorder in pregnancy and is more common in pregnant women than in healthy women and men. It affects 21.4% of pregnant women, especially in the third trimester. Genetics, brain dopamine system and iron metabolism are thought to be effective in the pathophysiology of the disease in pregnancy. If left untreated, complications such as sleep disturbance, psychological problems, decreased quality of life, preeclampsia, threat of miscarriage, premature birth, difficult birth, cesarean delivery and intrauterine growth retardation can be experienced, and the symptoms of the disease usually disappear after delivery.

The diagnosis of the disease is made using the basic criteria of the International Restless Legs Syndrome Working Group. The most important first-line treatment of the syndrome is iron supplementation to correct iron deficiency, which is very common in pregnancy. However, if the symptoms are severe, it may be necessary to use drugs that are reliable in the treatment, but non-pharmacological methods are recommended primarily. The second approach should be the use of behavioral and non-pharmacological treatments, especially during pregnancy. In the symptom management of RLS, besides controlling factors such as anemia, sleep apnea, drug use that exacerbates RLS; moderate exercise, yoga, hot/cold water applications, progressive relaxation exercises and sleep hygiene are recommended.

Anahtar Kelimeler

Pregnancy, Restless legs syndrome, Treatment.

Kaynakça

• Abdi, A., Shareef, O. H., Dalvand, S., Gheshlagh, R. G., & Dehkordi, A. H. (2021). Prevalence of restless legs syndrome in pregnant women: a systematic review and meta-analysis. Przegląd Epidemiologiczny, 75(3), 402-412.
• Allen, R. P., Picchietti, D. L., Auerbach, M., Cho, Y. W., Connor, J. R., Earley, C. J., ... & International Restless Legs Syndrome Study Group. (2018). Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report. Sleep medicine, 41, 27-44.
• Allen, R. P., Picchietti, D. L., Garcia-Borreguero, D., Ondo, W. G., Walters, A. S., Winkelman, J. W., ... & International Restless Legs Syndrome Study Group. (2014). Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria–history, rationale, description, and significance. Sleep medicine, 15(8), 860-873.
• Almeneessie, A. S., Alyousefi, N., Alzahrani, M., Alsafi, A., Alotaibi, R., Olaish, A. H., ... & Bahammam, A. S. (2020). Prevalence of restless legs syndrome among pregnant women: A case–control study. Annals of Thoracic Medicine, 15(1), 9.
• Aukerman, M. M., Aukerman, D., Bayard, M., Tudiver, F., Thorp, L., & Bailey, B. (2006). Exercise and restless legs syndrome: a randomized controlled trial. The Journal of the American Board of Family Medicine, 19(5), 487-493.
• Broussard, C. S., Rasmussen, S. A., Reefhuis, J., Friedman, J. M., Jann, M. W., Riehle-Colarusso, T., ... & Study, N. B. D. P. (2011). Maternal treatment with opioid analgesics and risk for birth defects. American journal of obstetrics and gynecology, 204(4), 314-e1.
• Budhiraja, P., Budhiraja, R., Goodwin, J. L., Allen, R. P., Newman, A. B., Koo, B. B., & Quan, S. F. (2012). Incidence of restless legs syndrome and its correlates. Journal of Clinical Sleep Medicine, 8(2), 119-124.
• Cesnik, E., Casetta, I., Turri, M., Govoni, V., Granieri, E., Strambi, L. F., & Manconi, M. (2010). Transient RLS during pregnancy is a risk factor for the chronic idiopathic form. Neurology, 75(23), 2117-2120.
• Cui, X., Pelekanos, M., Liu, P. Y., Burne, T. H. J., McGrath, J. J., & Eyles, D. W. (2013). The vitamin D receptor in dopamine neurons; its presence in human substantia nigra and its ontogenesis in rat midbrain. Neuroscience, 236, 77-87.
• Djokanovic, N., Garcia-Bournissen, F., & Koren, G. (2008). Medications for Restless Legs Syndrome in Pregnancy. Journal of Obstetrics and Gynaecology Canada, 30(6), 505-507.
• Dolovich, L. R., Addis, A., Vaillancourt, J. R., Power, J. B., Koren, G., & Einarson, T. R. (1998). Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and case-control studies. Bmj, 317(7162), 839-843.
• Dostal, M., Weber‐Schoendorfer, C., Sobesky, J., & Schaefer, C. (2013). Pregnancy outcome following use of levodopa, pramipexole, ropinirole, and rotigotine for restless legs syndrome during pregnancy: a case series. European journal of neurology, 20(9), 1241-1246.
• Dzaja, A., Wehrle, R., Lancel, M., & Pollmächer, T. (2009). Elevated estradiol plasma levels in women with restless legs during pregnancy. Sleep, 32(2), 169-174. Ekbom, K., & Ulfberg, J. (2009). Restless legs syndrome. Journal of internal medicine, 266(5), 419-431.
• Enato, E., Moretti, M., & Koren, G. (2011). The fetal safety of Benzodiazepines: An updated meta-analysis. Journal Of Obstetrıcs And Gynaecology Canada, 33(4), 319-319.
• Garcia-Borreguero D, Kohnen R, Silber MH, Winkelman JW, Earley CJ, Högl B, Manconi M, Montplaisir Jınoue Y, Allen RP. 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. Sleep Med, 2013; 14: 675–84.
• Georgieff, M. K. (2020). Iron deficiency in pregnancy. American journal of obstetrics and gynecology, 223(4), 516-524.
• Hachul, H., Baracat, E. C., Soares Jr, J. M., Abi Haidar, M., de Mello, M. T., Tufik, S., & Bittencourt, L. R. A. (2007). Estrogen therapy reduces nocturnal periodic limb movements. Maturitas, 58(3), 319-322.
• Hayes, C. A., Kingsley, J. R., Hamby, K. R., & Carlow, J. (2008). The effect of endovenous laser ablation on restless legs syndrome. Phlebology, 23(3), 112-117.
• Hurault-Delarue, C., Montastruc, J. L., Beau, A. B., Lacroix, I., & Damase-Michel, C. (2014). Pregnancy outcome in women exposed to dopamine agonists during pregnancy: a pharmacoepidemiology study in EFEMERIS database. Archives of gynecology and obstetrics, 290(2), 263-270.
• Jafarimanesh, H., Vakilian, K., & Mobasseri, S. (2020). Effects of Warm and Cold Footbath on Sleep Quality in Pregnant Women with Restless Legs Syndrome. The Iranian Journal of Obstetrics, Gynecology and Infertility, 23(6), 51-60.
• Kaplan, Ö., Başer, M. (2020). Huzursuz bacak sendromu olan gebelerde sıcak su uygulamasının etkisi: Randomize kontrollü çalışma, 6. International Gevher Nesibe Health Sciences Conference, 13 - 15 Kasım, Adana, 5-6.
• Lee, K. A., Zaffke, M. E., & Baratte-Beebe, K. (2001). Restless legs syndrome and sleep disturbance during pregnancy: the role of folate and iron. Journal of women's health & gender-based medicine, 10(4), 335-341.
• Lettieri, C. J., & Eliasson, A. H. (2009). Pneumatic compression devices are an effective therapy for restless legs syndrome: a prospective, randomized, double-blinded, sham-controlled trial. Chest, 135(1), 74-80.
• Lin, A. E., Peller, A. J., Westgate, M. N., Houde, K., Franz, A., & Holmes, L. B. (2004). Clonazepam use in pregnancy and the risk of malformations. Birth Defects Research Part A: Clinical and Molecular Teratology, 70(8), 534-536.
• Meerlo, P., Sgoifo, A., & Suchecki, D. (2008). Restricted and disrupted sleep: effects on autonomic function, neuroendocrine stress systems and stress responsivity. Sleep medicine reviews, 12(3), 197-210.
• Meneely, S., Dinkins, M. L., Kassai, M., Lyu, S., Liu, Y., Lin, C. T., ... & Clemens, S. (2018). Differential dopamine D1 and D3 receptor modulation and expression in the spinal cord of two mouse models of restless legs syndrome. Frontiers in Behavioral Neuroscience, 12, 199.
• Mitchell, U. H. (2011). Nondrug-related aspect of treating Ekbom disease, formerly known as restless legs syndrome. Neuropsychiatric Disease and Treatment, 7, 251. Montouris, G. (2003). Gabapentin exposure in human pregnancy: results from the Gabapentin Pregnancy Registry. Epilepsy & Behavior, 4(3), 310-317.
• Morrow, J. I., Russell, A., Guthrie, E., Parsons, L., Robertson, I., Waddell, R., ... & Craig, J. (2006). Malformation risks of antiepileptic drugs in pregnancy: a prospective study from the UK Epilepsy and Pregnancy Register. Journal of Neurology, Neurosurgery & Psychiatry, 77(2), 193-198.
• Oran, M., Unsal, C., Albayrak, Y., Tulubas, F., Oguz, K., Avci, O., ... & Gurel, A. (2014). Possible association between vitamin D deficiency and restless legs syndrome. Neuropsychiatric disease and treatment, 10, 953.
• Pereira Jr, J. C., Pradella-Hallinan, M., & Pessoa, H. D. L. (2010). Imbalance between thyroid hormones and the dopaminergic system might be central to the pathophysiology of restless legs syndrome: a hypothesis. Clinics, 65(5), 547-554.
• Picchietti, D. L., Hensley, J. G., Bainbridge, J. L., Lee, K. A., Manconi, M., McGregor, J. A., ... & International Restless Legs Syndrome Study Group. (2015). Consensus clinical practice guidelines for the diagnosis and treatment of restless legs syndrome/Willis-Ekbom disease during pregnancy and lactation. Sleep medicine reviews, 22, 64-77.
• Prosperetti, C., & Manconi, M. (2015). Restless legs syndrome/Willis-Ekbom disease and pregnancy. Sleep Medicine Clinics, 10(3), 323-329.
• Salminen, A. V., Lam, D. D., & Winkelmann, J. (2019). Role of MEIS1 in restless legs syndrome: from GWAS to functional studies in mice. Advances in Pharmacology, 84, 175-184.
• Silber, M. H., Ehrenberg, B. L., Allen, R. P., Buchfuhrer, M. J., Earley, C. J., Hening, W. A., ... & Medical Advisory Board of the Restless Legs Syndrome Foundation. (2004, July). An algorithm for the management of restless legs syndrome. In Mayo Clinic Proceedings, 79(7), 916-922.
• Sönmez, A., & Aksoy Derya, Y. (2018). Effects of sleep hygiene training given to pregnant women with restless leg syndrome on their sleep quality. Sleep and Breathing, 22(2), 527-535.
• Steinweg, K., Nippita, T., Cistulli, P. A., & Bin, Y. S. (2020). Maternal and neonatal outcomes associated with restless legs syndrome in pregnancy: a systematic review. Sleep Medicine Reviews, 54, 101359.
• Terzi, H., Terzi, R., Zeybek, B., Erenoglu, M., Hacivelioglu, S., Akdemir, A., Yeniel, O. (2015). Restless legs syndrome is related to obstructive sleep apnea symptoms during pregnancy. Sleep Breath, 19: 73–78.
• Toro, B. E. C. (2014). New treatment options for the management of restless leg syndrome. Journal of Neuroscience Nursing, 46(4), 227-232.
• Trenkwalder, C., & Paulus, W. (2010). Restless legs syndrome: pathophysiology, clinical presentation and management. Nature Reviews Neurology, 6(6), 337-346.
• Whiteman, V. E., Salemi, J. L., Mogos, M. F., Cain, M. A., Aliyu, M. H., & Salihu, H. M. (2014). Maternal opioid drug use during pregnancy and its impact on perinatal morbidity, mortality, and the costs of medical care in the United States. Journal of pregnancy, 2014.
• Yüksel, E. (2017). Gebelerde progresif gevşeme egzersizlerinin huzursuz bacak sendromu şiddetine ve uyku kalitesine etkisi. (Yüksek Lisans Tezi) Ege Üniversitesi Sağlık Bilimleri Enstitüsü, İzmir.