uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Pre-pregnancy Restless Legs Syndrome (Willis-Ekbom Disease) Is Associated with Perinatal Depression
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.ORCID iD: 0000-0002-4935-7532
Sleep & Epilepsy Center Bellinzona, TI, Switzerland .
Sleep & Epilepsy Center Bellinzona, TI, Switzerland .
Show others and affiliations
2014 (English)In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, Vol. 10, no 5, 527-533 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: Both restless legs syndrome ([RLS], also known as Willis-Ekbom Disease [WED]) and depression are common during pregnancy. However, no prior studies have assessed if pregnant women with RLS have an elevated risk of depression during and/or after pregnancy.

Methods: 1,428 women who were pregnant in gestational week 16-17 were asked to participate in a longitudinal survey. They were followed by web-based questionnaires in gestational week 17 and 32, and 6 weeks after delivery. Data were also retrieved from prenatal and birth records. Two different sets of criteria were used to examine the prevalence of RLS in the cohort (International Restless Legs Syndrome Society Group standard criteria and the later developed CH-RLSQ11 questionnaire). The latter questionnaire attempts to exclude those with common "mimics" of RLS.

Results: Adjusted odds ratio for depression in gestational week 17, 32, and postpartum week 6 in relation to pre-pregnancy RLS onset and moderate to severe symptom severity were 4.74 (2.30 - 9.76), 3.67 (1.85 - 7.28), and 2.58 (1.28 - 5.21), respectively. No significant associations were seen in pregnant women with de novo RLS during pregnancy. When using the standard diagnostic RLS criteria and frequency of symptoms more than 2-3 days per week, the prevalence of RLS was 12.3%. With the CH-RLSQ11 questionnaire and the same threshold for frequency of symptoms the prevalence was 6.5%.

Conclusion: Women with RLS onset before pregnancy with moderate or severe symptoms had an increased risk of both antenatal and postnatal depression. The self-reported prevalence of RLS during pregnancy is lower when a questionnaire dealing with "mimics" is used.

Place, publisher, year, edition, pages
2014. Vol. 10, no 5, 527-533 p.
Keyword [en]
Restless legs syndrome, pregnancy, depression
National Category
Obstetrics, Gynecology and Reproductive Medicine Neurology Psychiatry
Research subject
URN: urn:nbn:se:uu:diva-204150DOI: 10.5664/jcsm.3704ISI: 000341135100011OAI: oai:DiVA.org:uu-204150DiVA: diva2:637901
Available from: 2013-07-23 Created: 2013-07-22 Last updated: 2016-06-21Bibliographically approved
In thesis
1. Sleep Related Movement Disorders: Association with Menopause and Pregnancy
Open this publication in new window or tab >>Sleep Related Movement Disorders: Association with Menopause and Pregnancy
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

It is known that sleep problems affect people’s wellbeing and has great consequences for public health.

Restless legs syndrome (RLS) gives uncomfortable sensations in the legs at rest, leading to an irresistible need for activity. It aggravates in evening and at night. Therefore, RLS provides poorer sleep and can affect quality of life through fatigue, family life and social activities, work, and comorbidity. It is demonstrated a dysfunction of the dopaminergic system in the brain with low levels of dopamine and / or less sensitive dopamine receptors. RLS is more common in women and the prevalence increases with age and during pregnancy.

Periodic limb movements are characterized by uncontrolled stretching movements of the legs, especially the toes, ankles, knees and hips during sleep. They last between 0.5 and 5 seconds, and can cause brief awakenings leading to daytime sleepiness. The clinical significance of PLM is rather controversial and PLM is sometimes seen in healthy people with no daytime symptoms.

RLS is a subjective diagnosis and translated with the help of questionnaires. PLM however, can objectively be evaluated by polysomnography.

Depression is common during and after pregnancy. It is not known whether women with RLS during pregnancy have a higher risk of prenatal or postpartum depression.

The aims of this thesis was to  to examine the prevalence, associated symptoms and comorbidities, in particular, vasomotor symptoms, menopause, and hormone replacement therapy (HRT) use, among women who suffer from RLS and PLMs. We also evaluated the impact of RLS and PLMs on health related quality of life (HRQoL), and if RLS before and during pregnancy increases the risk of antenatal or postpartum depressive symptoms.

Three different poulations were used.  Paper 1-3 were cross-sectional and included 5000 resp. 10000 randomly selected women from the general populations of Dalarna and Uppsala County. Questionnaires, polysomnographic recordings, blodtests etc. were used. Paper 4 was a longitudinal cohort study where 1428 pregnant women in Uppsala County were followed.

In summary, data included in this thesis points out that RLS and PLMs are more common in women with estrogendeficiency-related symptoms of menopause. RLS-positive women had an impaired mental HRQoL compared to RLS-negative women and more often suffered from comorbidities. Data also revealed that women with RLS before and during pregnancy are at increased risk for depression during and after pregnancy.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 74 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 915
Sleep, Restless Legs Syndrome, Women, Menopause, Pregnancy, Depression
National Category
Other Clinical Medicine
Research subject
urn:nbn:se:uu:diva-204149 (URN)978-91-554-8703-4 (ISBN)
Public defence
2013-09-06, Gustavianum, Akademigatan 3, Uppsala, 09:15 (English)
Available from: 2013-08-16 Created: 2013-07-22 Last updated: 2014-01-07Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text

Search in DiVA

By author/editor
Wesström, JanSkalkidou, AlkistisSundström Poromaa, Inger
By organisation
Obstetrics and Gynaecology
In the same journal
Journal of Clinical Sleep Medicine (JCSM)
Obstetrics, Gynecology and Reproductive MedicineNeurologyPsychiatry

Search outside of DiVA

GoogleGoogle Scholar

Altmetric score

Total: 238 hits
ReferencesLink to record
Permanent link

Direct link