Restless Legs Syndrome In Pregnancy

Overview

Restless legs syndrome (RLS) is a condition that causes an overwhelming urge to move your legs due to uncomfortable sensations. There appears to be a link between restless legs and pregnancy, with many pregnant women suffering from the condition, particularly in the third trimester. Primarily, lifestyle adjustments help to manage symptoms. Most cases resolve soon after giving birth. If RLS is affecting you day to day, even after childbirth, it is worth consulting your doctor. 

What is restless legs syndrome (RLS)?

Restless legs syndrome is a condition defined by an overwhelming need to move your legs, due to uncomfortable sensations such as crawling or creeping in the lower limbs.¹ These sensations often become more prominent in the evening or at night, and can significantly affect sleep patterns. Generally, they worsen at rest and get better with movement. Occasionally, some people may experience similar symptoms in their arms also.²

How common is RLS in pregnancy?

 RLS and pregnancy are found highly correlated, particularly during the third trimester. Some evidence suggests as many as 1 in 3 pregnant women experience RLS symptoms in the last 3 months of their pregnancy.³ Most of these symptoms improve postpartum, with only 6.8% of women experiencing symptoms after giving birth.⁴ 

What are the causes of RLS?

Although the precise causes and origin of RLS during pregnancy are still unclear, several potential factors have been linked to this condition. 

Hormones 

Certain hormonal changes that occur in pregnancy may play a role in the development of RLS. The production of oestrogen, progesterone and prolactin hormones increases during the third trimester.⁴ Evidence suggests that these hormones affect the action of dopamine in the body, which plays a role in the development or worsening of RLS.¹

Iron

Low iron and folate levels during pregnancy have been connected to RLS.^1,4,5 During pregnancy, the amount of blood in your body naturally increases to supply the foetus; this increases the risk of iron-deficiency anaemia which is known to be a risk factor for RLS. 

Vitamin D

Pregnant women often suffer from lower levels of vitamin D.⁶ Some evidence postulate lower vitamin D levels increase the chance of developing RLS due to its effect on dopamine transmission.¹

Genetics

Although there is no known cause for restless legs syndrome, which is why it is known as idiopathic restless legs syndrome, it often appears to run in families.² For women who are genetically predisposed to the condition, pregnancy may trigger symptoms of RLS.⁴

What are the symptoms of RLS?

Symptoms of RLS can range from mild to severe. Some will only occasionally experience symptoms, others can suffer everyday. A severe form of RLS may have a huge impact on quality of life. 

Some of the common symptoms include:

• Urgent need to move your legs
• Unpleasant sensations in legs such as crawling, creeping or aching
• Worsening symptoms in the evening or at night 
• improvement was seen with movement 
• Occasionally, RLS can be linked to involuntary movements of the legs and arms, called periodic limb movements

Diagnosis 

A diagnosis of RLS is made based on your symptoms and medical history, rather than a specific medical test. The following diagnostic criteria are often used:⁷

• An urgent need to move the legs due to uncomfortable sensations
• The symptoms are worse at rest and eased by activity
• The symptoms are worse at night
• The symptoms can't be explained by another medical or behavioural condition 

Blood tests to check for iron and vitamin D deficiency may also be undertaken. 

How to treat restless legs when pregnant?

 Restless Legs Syndrome that is caused by an under-lying condition may be cured by treating that condition. For example, RLS caused by iron-deficiency anaemia may be resolved by taking iron tablets. 

For idiopathic RLS, non-pharmacological treatments are the primary form of treatment during pregnancy, focusing on managing the symptoms. For most cases, a number of lifestyle changes will be suggested to ease the symptoms as follows:

• Avoid drinking coffee, soda and other caffeinated drinks 
• Stop smoking 
• Being active -exercising legs everyday
• Try to adopt a regular sleep routine - going to bed and getting up at the same time everyday
• Have a good bedtime routine such as a warm bath or reading a book

If an episode of restless legs occurs, some simple steps may ease you such as::

• Massage your leg muscles
• Take a hot bath 
• Try to distract yourself by doing something else
• Get up and move - walking and stretching can help

In severe cases, medications such as opioids or dopamine agonists are sometimes used.¹² However, these are used under medical consultation and cautiously during pregnancy.

Does RLS have any impact on foetal and maternal health?

The biggest impact of RLS on maternal health appears to be its effect on the quality of sleep. Pregnant women who suffer from RLS have more difficulty in falling and staying asleep. Their poor quality of sleep affects their ability to function well during daytime.⁸ This sleep deprivation has shown association to adverse pregnancy outcomes, including preeclampsia, increased risk of Caesarean section, and depression.^8,9 However, it is still unclear whether RLS itself causes these adverse outcomes, or the condition shares the causal pathway with other comorbidities. There is currently no association between RLS and low birth weight or pre-term birth.⁸ Those who suffer from RLS during pregnancy are 4 times more likely to be at risk of developing RLS outside of pregnancy. Furthermore, there is a 30% increase in recurrence of RLS in future pregnancies.¹⁰

FAQ’s

At which stage of pregnancy do you get restless legs?

Restless legs can occur at any point during pregnancy. However, more women seem to experience RLS during the third trimester. In fact, some evidence suggests as many as 1 in 3 pregnant women experience RLS symptoms in the last 3 months of their pregnancy. 

How can I manage restless legs during pregnancy?

If you have not suffered from restless legs before, it is important to consult your doctor to discuss your symptoms. They may run some tests to check for any underlying health conditions, such as anaemia. Most cases of RLS are idiopathic, which means there is no known cause and they focus on managing the symptoms. It is important to stop smoking, reduce caffeine and exercise regularly to prevent aggravation. A regular sleep routine can be of great help. If an episode of RLS occurs, a gentle massage on your legs, a hot shower/bath can help you ease the symptoms.

Will restless legs syndrome go away after I’ve given birth?

Yes, most women find that their restless legs improve and eventually go away in the weeks after giving birth. There are a small number of women who will continue to experience symptoms postpartum, which is estimated to be 6.8%.⁴ 

Summary

Restless legs syndrome (RLS) is a condition that results in an overwhelming urge to move your legs due to uncomfortable sensations. There is a link between restless legs and pregnancy, with many pregnant women suffering from the condition, particularly in the third trimester. Generally, lifestyle changes are suggested to prevent worsening the symptoms.. Most cases will resolve soon after giving birth. If RLS is affecting you day to day even after giving birth, it is worth consulting your doctor.