Gestational Restless Legs Syndrome

Abstract

Gestational restless legs syndrome (gRLS) is a common and often unrecognized symptom constellation that can lead to discomfort, sleep fragmentation, reduced total sleep time, daytime somnolence and disrupt mood and quality of life. The prevalence of gRLS is 11–34 %. There is a steady rise in restless legs syndrome (RLS) symptoms during pregnancy, which rapidly declines in the postpartum period. The etiology of gRLS remains undetermined. Genetic factors, peripheral and/or central iron storage deficiencies, reduction in central dopamine production and/or its receptors, pregnancy-related hormonal influences, and altered neuronal function have all been attributed to causing or worsening gRLS. When discovered, other conditions that can produce or mimic gRLS should be investigated, including diabetes, iron deficiency, hypothyroidism, renal insufficiency, and neuropathy. A number of pharmacologic therapies are available, though their use in pregnancy poses many obstacles. Iron and folate supplementation should be implemented. A review of concurrent medications and limiting agents that may exaggerate RLS can often produce improvement. Non-pharmacological strategies are the mainstay of treatment. Although most women will have resolution of RLS symptoms in the weeks immediately prior to or following birth, there is an increased risk of symptom recurrence with future pregnancies or later in life.