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

Daniel L Picchietti; Jennifer G Hensley; Jacquelyn L Bainbridge; Kathryn A Lee; Mauro Manconi; James A McGregor; Robert M Silver; Claudia Trenkwalder; Arthur S Walters; International Restless Legs Syndrome Study Group (IRLSSG)

doi:10.1016/j.smrv.2014.10.009

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

Sleep Med Rev. 2015 Aug:22:64-77. doi: 10.1016/j.smrv.2014.10.009. Epub 2014 Nov 4.

Authors

Daniel L Picchietti¹, Jennifer G Hensley², Jacquelyn L Bainbridge³, Kathryn A Lee⁴, Mauro Manconi⁵, James A McGregor⁶, Robert M Silver⁷, Claudia Trenkwalder⁸, Arthur S Walters⁹; International Restless Legs Syndrome Study Group (IRLSSG)

Affiliations

¹ University of Illinois College of Medicine at Urbana-Champaign and Carle Foundation Hospital, Urbana, IL, USA. Electronic address: dpicchie@illinois.edu.
² College of Nursing, University of Colorado Denver, Aurora, CO, USA.
³ Department of Clinical Pharmacy and Department of Neurology, University of Colorado Denver, Aurora, CO, USA.
⁴ Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA.
⁵ Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland.
⁶ Department of Obstetrics and Gynecology, Women's and Children's Hospital, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁷ Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA.
⁸ Paracelsus-Elena Hospital, Center of Parkinsonism and Movement Disorders, Kassel, Germany; Department of Neurosurgery, University Medical Center, Goettingen, Germany.
⁹ Department of Neurology Vanderbilt University School of Medicine, Nashville, TN, USA.

PMID: 25553600
DOI: 10.1016/j.smrv.2014.10.009

Abstract

Restless legs syndrome (RLS)/Willis-Ekbom disease (WED) is common during pregnancy, affecting approximately one in five pregnant women in Western countries. Many report moderate or severe symptoms and negative impact on sleep. There is very little information in the medical literature for practitioners on the management of this condition during pregnancy. Accordingly, a task force was chosen by the International RLS Study Group (IRLSSG) to develop guidelines for the diagnosis and treatment of RLS/WED during pregnancy and lactation. A committee of nine experts in RLS/WED and/or obstetrics developed a set of 12 consensus questions, conducted a literature search, and extensively discussed potential guidelines. Recommendations were approved by the IRLSSG executive committee, reviewed by IRLSSG membership, and approved by the WED Foundation Medical Advisory Board. These guidelines address diagnosis, differential diagnosis, clinical course, and severity assessment of RLS/WED during pregnancy and lactation. Nonpharmacologic approaches, including reassurance, exercise and avoidance of exacerbating factors, are outlined. A rationale for iron supplementation is presented. Medications for RLS/WED are risk/benefit rated for use during pregnancy and lactation. A few are rated "may be considered" when RLS/WED is refractory to more conservative approaches. An algorithm summarizes the recommendations. These guidelines are intended to improve clinical practice and promote further research.

Keywords: Consensus; Lactation; Pregnancy; Restless legs syndrome; Sleep disorder; Willis-Ekbom disease.

Publication types

Consensus Development Conference
Practice Guideline
Research Support, Non-U.S. Gov't
Review

MeSH terms

Diagnosis, Differential
Female
Humans
Lactation*
Pregnancy
Pregnancy Complications / diagnosis*
Pregnancy Complications / therapy
Restless Legs Syndrome / complications*
Restless Legs Syndrome / diagnosis
Restless Legs Syndrome / therapy