title: Consensus clinical practice guidelines for the diagnosis and treatment of restless legs syndrome/Willis-Ekbom disease during pregnancy and lactation.
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.
authors.affiliation: University of Illinois College of Medicine at Urbana-Champaign and Carle Foundation Hospital, Urbana, IL, USA. Electronic address: dpicchie@illinois.edu.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Picchietti
authors.affiliation: College of Nursing, University of Colorado Denver, Aurora, CO, USA.
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Hensley
authors.affiliation: Department of Clinical Pharmacy and Department of Neurology, University of Colorado Denver, Aurora, CO, USA.
authors.forename: Jacquelyn L
authors.initials: JL
authors.lastname: Bainbridge
authors.affiliation: Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Lee
authors.affiliation: Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland.
authors.forename: Mauro
authors.initials: M
authors.lastname: Manconi
authors.affiliation: Department of Obstetrics and Gynecology, Women's and Children's Hospital, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: McGregor
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Silver
authors.affiliation: Paracelsus-Elena Hospital, Center of Parkinsonism and Movement Disorders, Kassel, Germany; Department of Neurosurgery, University Medical Center, Goettingen, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Trenkwalder
authors.affiliation: Department of Neurology Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Walters
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007774:Lactation; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000628:therapy; D012148:Restless Legs Syndrome / Q000150:complications* / Q000175:diagnosis / Q000628:therapy
keywords: Consensus; Lactation; Pregnancy; Restless legs syndrome; Sleep disorder; Willis-Ekbom disease