Handling Restless Legs Syndrome in Pregnancy

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The Pulse covered the basics on restless legs syndrome (RLS) back in 2017. RLS is a common condition in pregnancy. It may affect about 20 percent of pregnant women. A recent review of the management of RLS in pregnancy was published in the Journal of Primary Care & Community Health. It adds some important information, including the good news that three out of four women can manage their symptoms without medications.

A Quick Review

RLS is also called Willis-Ekbom disease. It causes an intense and unpleasant urge to move your legs. The urge is worse when resting and at night, and it gets better when you get up and move. The diagnosis is based on the symptoms.

RLS may start in pregnancy or get worse in pregnancy for someone who already has RLS. Normal pregnancy symptoms like leg cramps and the discomfort of pregnancy edema in the legs can mimic RLS, and it is estimated that about 40 percent of pregnant women who are told they have RLS are only having these symptoms.

The cause of RLS is not completely understood. It has something to do with low levels of a chemical messenger (neurotransmitter) called dopamine. Low levels of dopamine also cause Parkinson’s disease. RLS also has a genetic component, since it tends to run in families. In pregnancy, low levels of iron may affect the nerve cells that produce dopamine.

You may be at higher risk for RLS during pregnancy if you have a family history of RLS. You are at much higher risk if you had RLS in a previous pregnancy. Other risk factors include low levels of iron (low hemoglobin) and not getting enough sleep.

What to Do for RLS in Pregnancy

First of all, let your doctor know about the symptoms. It is important to differentiate RLS from leg cramps and edema of pregnancy. RLS in pregnancy can range from mild to severe. It may occur a few times per week or every time you try to rest or sleep. In severe cases, it can lead to sleep deprivation or even depression. The recent review and recommendations from the RLS Foundation give these management tips:

  • Get some low impact, aerobic exercise every day.
  • Don’t get sleep deprived. RLS is better during the day, so take a nap in the afternoon if you are tired.
  • Focused mental concentration often blocks RLS symptoms. Try doing an activity like a puzzle, knitting, or a computer game when resting during the day.
  • Avoid long periods of inactivity.
  • Practice good sleep habits. Go to bed and get up about the same time. Keep your bedroom quiet, comfortable, and dark. Use your bedroom for sleep, not TV or computer.
  • Caffeine has a greater effect during pregnancy. If you drink a caffeinated beverage, keep it to early in the day.
  • Avoid over-the-counter drugs with antihistamines. They may trigger RLS
  • Try yoga and massage therapy. Both of these help some people with RLS.
  • Not smoking or drinking alcohol goes without saying in pregnancy, but both of these also trigger RLS symptoms.

What About Medications?

According to the review, three out of four pregnant women can manage RLS without medications. If your iron level is low or borderline low, your doctor may add an iron supplement to get your iron level to mid-range normal. If you have nausea or vomiting of pregnancy, and need a medication, the safest medication is ondansetron (Zofran). Other medications used for morning sickness may trigger RLS.

RLS medications may be used for managing RLS if lifestyle changes and iron supplements do not help. Although these medications have not been studied enough to say they are safe during pregnancy, the benefit may outweigh the risk if RLS is causing exhaustion or depression. These medications are used later in pregnancy (after the first trimester), to lower any risk of birth defects. According to the recent review, these are the possible options:

  • The benzodiazepam (anti-anxiety) medication clonazepam (Klonopin) may be used during later pregnancy or during breastfeeding.
  • The dopamine replacement medication Sinemet may be used in later pregnancy, but not during breastfeeding, as it decreases milk production (lactation).
  • The anti-seizure medication gabapentin (Neurontin) may be used in later pregnancy or during breastfeeding.
  • Low dose opioids like Tramadol or oxycodone may be used later in pregnancy or while breastfeeding.

What’s the Prognosis?

RLS usually starts in the second trimester of pregnancy and may start to get better near the end of the third trimester. Having had RLS during pregnancy, even if it goes away, increases the risk of having RLS in the future by about 30 percent. It significantly increases the risk of having RLS during a future pregnancy. On the good side, 90 percent of women will be symptom-free within one month after delivery. Seventy percent of women will be symptom-free by the time of delivery.

Christopher Iliades
Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.

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