March 9, 2021

By Emeline Mugisha, MSN, MPH, RN

Restless legs syndrome (RLS) is a common health problem during pregnancy. Studies show that RLS is two to three times higher in pregnant women than non-pregnant women, suggesting that pregnancy is a significant risk factor for RLS. While the condition is fortunately not life-threatening, severe cases may disrupt a person’s quality of life and daily activities.

What is restless legs syndrome (RLS)?

RLS is a condition that causes an involuntarily and sometimes overwhelming desire to move your legs, typically because of uncomfortable sensations in your feet, calves, and thighs.

Though it’s often difficult to explain what RLS feels like, people generally describe abnormal, unpleasant feelings, such as throbbing, aching, tingling, crawling, or pulling. These sensations may affect one side but most often affect both sides of your body and are felt within the limbs rather than on the skin's surface. In some cases, RLS may also affect your arms.

The main symptom of RLS is an urge to move your legs. Other significant features may include:

• Sensations that usually occur when you are inactive, sitting for a long time, or lying down
• Relief with movement (pacing, moving your legs while sitting, tossing and turning in bed)
• Symptoms that worsen in the evening when in a relaxing or resting position
• Sleep problems (leg twitching or kicking, difficulty falling or staying asleep)
• Fatigue and daytime sleepiness, which impacts daytime functioning

RLS may begin at any age and can range from mild to severe. Additionally, symptoms vary depending on the day, person, and duration of the illness. For example, some people may have symptoms occasionally, while others may have them every day. However, symptoms generally come and go during the early stages of RLS and become more frequent and severe with time.

There are two different types of RLS: primary and secondary. Primary RLS tends to affect multiple family members and has no known cause. In most cases, the cause of RLS is unknown, making primary RLS more common. Secondary RLS occurs less often and has a known cause.

Examples of secondary RLS include RLS that develops due to pregnancy or medical conditions, such as kidney disease, heart disease, or iron deficiency.

How common is restless legs syndrome (RLS) during pregnancy and postpartum?

RLS affects about 1 in 5 pregnant women, and most cases occur during the third trimester (the last three months of pregnancy). Often, RLS either appears for the first time or worsens in pregnancy. In most cases, symptoms of RLS disappear within four weeks of giving birth.

Research suggests that both childbirth and the number of deliveries are risk factors for RLS. Specifically, women who have given birth are more likely to develop RLS than women who haven’t given birth. And, the risk of RLS is higher among women who have had multiple births.

It remains unclear why there is a link between RLS and pregnancy.

What is the connection between restless legs syndrome (RLS) and perinatal mental health?

Whether pregnancy-related or not, untreated RLS may lead to exhaustion and fatigue, which impacts daytime concentration and may trigger depression. In general, conditions that reduce the quality of sleep you receive also harm your overall well-being, including mental health.

A 2020 study found that moms with RLS during pregnancy and 12 weeks postpartum have a higher risk of developing baby blues shortly after birth. While the study found no connection between RLS in pregnancy and postpartum depression, women who experienced RLS were more likely to have a history of mental illness and exposure to stressful life events.

How can I alleviate pregnancy-related restless legs syndrome (RLS)?

Non-drug therapies, such as self-management and lifestyle changes, can help relieve mild RLS.

Self-management strategies include:

• Moving your legs (relief may be temporary or disappear once the movement stops)
• Massaging your legs
• Participating in activities that distract your mind, such as reading or relaxation exercises
• Applying a hot or cold compress
• Stopping activities that worsen your symptoms

Lifestyle changes include:

• Avoiding the use of caffeine and alcohol close to bedtime
• Exercising regularly during the day and avoiding exercise close to bedtime
• Maintaining a healthy sleep schedule (going to bed and waking up at the same time each day, and getting the amount of sleep you need to feel refreshed)
• Avoiding medications that trigger or worsen your symptoms (if you think your symptoms are related to medications, consult a health care provider before stopping them)
• Quitting smoking

If your symptoms are severe or do not improve with non-drug therapies, you may require medication. Speak with your provider to develop a treatment plan that will work best for you.

Sources

Goecke, T. W., Schnakenberg, P., Frensch, M., & Chechko, N. (2020). Restless legs syndrome during pregnancy and 12 weeks postpartum and its links to cardiovascular diseases, stressful life events, and psychiatric history. Journal of Clinical Medicine, 9(9), 3046. https://doi.org/10.3390/jcm9093046

National Health Service (UK). (2018, August 16). Restless legs syndrome. https://www.nhs.uk/conditions/restless-legs-syndrome/treatment/

Srivanitchapoom, P., Pandey, S., & Hallett, M. (2014). Restless legs syndrome and pregnancy: a review. Parkinsonism & Related Disorders, 20(7), 716–722. https://doi.org/10.1016/j.parkreldis.2014.03.027



Emeline Mugisha, MSN, MPH, RN - Emeline Mugisha is an award-winning, master's-prepared nurse with over a decade of experience in community/public health and clinical health services at the field and management levels. She has co-authored two professional manuscripts in Women's Health Issues and the Journal of Midwifery and Women's Health. She has an M.S. in Public Health Nursing and an M.P.H. from Johns Hopkins University.