What Causes Restless Legs In Pregnancy And How To Manage

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Experiencing restless legs in pregnancy is quite common and occurs in around 10–34% of all pregnancies. Also known as Willis-Ekbom disease, restless legs syndrome (RLS) is a common sleep disorder due to a neurological sensory-motor dysfunction. It causes an unusual, creepy feeling in the lower extremities, leading to an insatiable desire to move the leg and relieve the discomfort (1) (2).

Read on to know the various causes and symptoms of restless legs syndrome during pregnancy and how it can be treated.

Is RLS Bad For Pregnancy?

While RLS can be uncomfortable and may hamper sleep, it does not cause any adverse effects on the fetus or the mother during pregnancy. (3) However, pregnant women with RLS may also experience periodic limb movements of sleep (PLMS), nocturnal leg cramps, and sleepiness during the day.

Some women may have insomnia due to RLS. Sleep duration and sleep quality could influence maternal mental health, the type of delivery, length of labor, the neonate’s APGAR scores, and birth weight.

In rare cases, women with RLS may be at a higher risk of developing pregnancy complications such as abortion, premature labor, difficult delivery, preeclampsia, and intrauterine growth retardation (1).

When Does RLS Start During Pregnancy?

Symptoms of RLS begin to appear in the third trimester. The symptoms mostly disappear after delivering the baby (2). For women who already experience RLS, pregnancy may worsen the condition (4).

Symptoms Of Restless Legs Syndrome

The primary complaint of women with RLS is the overwhelming urge to move the legs. Pregnant women may generally describe the unpleasant sensation in the legs as (3):

  • Tingling
  • Burning
  • Itching
  • Creeping or crawling, like ants moving up and down the legs
  • Feeling like fizzy water is flowing through the veins

These sensations are worse below the knee and may also be painful at times. Some women complain of the symptoms getting worse when they rest and feel better when they walk. The symptoms might worsen in the evening or at night. RLS may make it difficult for the affected woman to get a good night’s sleep.

Causes Of RLS

The exact cause of RLS in pregnant women is unknown. Hormonal changes might be responsible for causing RLS in pregnant women. The following factors may put one at a higher risk of developing RLS (1) (2) (3).

  • Iron-deficiency anemia; a common condition in pregnancy that may worsen RLS
  • Excess consumption of alcohol and caffeine
  • Neurological conditions such as Parkinson’s disease and multiple sclerosis
  • Circulatory changes
  • Rheumatoid arthritis
  • Diabetes
  • Hypothyroidism
  • High BMI
  • Decrease in dopamine levels
  • Psychological or mechanical factors
  • Strain on the lumbosacral nerve root due to the growing size of the fetus
  • Peptic ulcer disease before pregnancy
  • Vitamin D deficiency
  • Smoking
  • Genetic factors
  • High levels of estradiol, prolactin, and increased progesterone during pregnancy

The following medications may also lead to or worsen the symptoms of RLS.

  • Antidepressants
  • Antipsychotic drugs
  • Lithium
  • Antiepileptic drugs
  • Antihistamines
  • Dopamine receptor blocking agents such as metoclopramide and prochlorperazine
  • Beta-blockers

Treatment For RLS

Pharmacological management of RLS is usually avoided in pregnant women. The doctor may recommend the following measures for relief from RLS (3).

  • Regular mild exercises such as walking and stretching
  • Relaxation exercises
  • Elastic compression stockings
  • Heat pad application on legs
  • Distraction techniques such as reading or listening to music
  • Leg massages
  • Oral supplementation to help with iron and/or vitamin D deficiency
  • Cessation of smoking and alcohol consumption
  • Reduction or avoidance of caffeine intake

If conservative approaches do not work, the doctor might prescribe medications, depending on the woman’s health, stage of pregnancy, severity of the symptoms, and presence of other problems (3).

Medicines are typically used for the shortest possible duration and at the lowest dosage. Avoid taking any OTC drugs and contact your healthcare provider if you wish to have medicines to reduce symptoms of RLS in pregnancy.

  • Antiepileptics
  • Benzodiazepine
  • Dopaminergic
  • Opioids
  • Blood pressure medications
  • Anticonvulsants
  • Clonazepam
  • Clonidine

The doctor will prescribe medicines for the shortest possible duration and at the lowest dosage. Avoid taking any OTC drugs and contact your healthcare provider if you wish to have a medicine to reduce symptoms of RLS in pregnancy.

Things That Worsen RLS

The following substances and lifestyle choices may worsen RLS symptoms.

  • Caffeine
  • Smoking
  • Certain medicines such as antihistamines in cold and allergy remedies
  • Lying in bed for too long apart from when you sleep
  • Watching television or reading while lying in the bed

Frequently Asked Questions

1. Is tonic water good for leg cramps in pregnancy?

Tonic water contains a low concentration of the drug quinine. This drug has been shown to have oxytocic effects and may increase insulin secretion, resulting in low blood glucose. However, hypoglycemia may be problematic, particularly in late pregnancy (5).

2. How long does RLS last during pregnancy?

The symptoms of restless leg syndrome usually seem to improve within the first four weeks after childbirth (6). While some women may get relief within days, some might take weeks.

Restless legs in pregnancy can affect your sleep due to periodic leg movements and leg cramps. This may begin in the third trimester and ends with delivery in most cases. Although it does not directly affect the mother or baby, good quality sleep is essential for maternal health. Pregnancy issues such as miscarriage, early birth, hypertension, and intrauterine development retardation are rarely linked to this illness. Leg massage, relaxation techniques, and exercises are recommended for pregnant women with restless legs.

Key Pointers

  • While restless legs syndrome (RLS) may cause discomfort in pregnancy, it does not adversely affect the fetus.
  • For most cases, the symptoms of RLS begin to appear in the third trimester and subside after childbirth.
  • Women suffering from this condition may complain of tingling, burning, itching, etc.
  • Hyperthyroidism, diabetes, and smoking are a few factors that increase the risk of developing RLS.

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
  1. Restless legs syndrome and pregnancy: prevalence possible pathophysiological mechanisms and treatment.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5562408/
  2. Prevalence of Restless Leg Syndrome in Pregnancy.
    https://www.ijhsr.org/IJHSR_Vol.10_Issue.9_Sep2020/8.pdf
  3. What can I do about restless legs syndrome during pregnancy?.
    https://www.tommys.org/pregnancy-information/im-pregnant/restless-legs-syndrome
  4. RLS in pregnancy.
    https://www.rls-uk.org/rls-in-pregnancy
  5. USE OF QUININE IN PREGNANCY.
    https://www.medicinesinpregnancy.org/bumps/monographs/USE-OF-QUININE-IN-PREGNANCY/
  6. R. Gupta et al.; (2016); Restless legs syndrome and pregnancy: prevalence possible pathophysiological mechanisms and treatment.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5562408/
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Dr. Ng Kai Lyn

(MMed (O&G), MRCOG)
Dr. Ng Kai Lyn is a Singapore-based obstetrician and gynecologist, specializing in urogynecology, minimally invasive surgery, and clinical interest in fertility. She has vast experience managing and treating benign gynecological conditions, including uterine fibroids, ovarian cysts, endometrial polyps, and endometriosis. She is also fellowship trained in urogynecology. She manages pelvic organ prolapse, pelvic floor reconstructive surgery, overactive bladder, urinary incontinence,... more

Dr. Ritika Shah

Dr. Ritika Shah is a dental surgeon with more than seven years of clinical experience across various cities in India. During her clinical practice, pediatric dentistry was her particular area of interest, and she constantly thrived to inculcate the latest advancements in the field of dentistry into her practice. She also holds a certificate in lactation counselling from iNational Health... more

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