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RLS in pregnancy

Clinical bottom line

The prevalence of RLS is as high as 26% in the months before delivery, but by six months after delivery RLS has disappeared in women who did not have it before pregnancy.


Reference

M Manconi et al. Restless legs syndrome and pregnancy. Neurology 2004 63: 1065-1069.

Study

This was a consecutive study of 642 pregnant women in Italy over two years. Of these 626 participated. Exclusions were women with pre-eclampsia or eclampsia, severe ankle oedema, and diseases known to cause RLS, as well as women receiving drug therapy apart from iron and folate.

Women were interviewed soon after giving birth with a structured questionnaire administered by physicians expert in sleep therapy. The interview asked about details of mother and baby, and RLS symptoms before, during, and after pregnancy. Laboratory data were also collected. Those women suffering RLS were additionally interviewed by telephone one, three and six months after birth. RLS was defined according to current criteria.

Results

The 606 women with evaluable data had a mean age of 32 years, and mean pregnancy duration of 38 weeks. More than three quarters received iron and folate supplements during pregnancy. Most (77%) reported reduced sleep quality during pregnancy.

Prevalence of RLS during pregnancy was 27%. Among 161 women reporting RLS, 101 never experienced it previously (17%), and 60 were already experiencing RLS before pregnancy (10%). Symptoms occurring at least once a week were found in 24% of women, and 15% experienced symptoms at least three times a week. RLS prevalence increased dramatically in the months before delivery (Figure 1), and the increase was more rapid and greater in women with new RLS. After delivery RLS declined, and by six months after delivery had all but disappeared in women who had not experienced restless legs before their pregnancy.

Figure 1: RLS during and after pregnancy

Women with RLS had babies with similar birthweight to those without RLS, and delivered at the same average gestation. They did have lower mean haemoglobin levels. Women with RLS had significantly poorer sleep (about 50 minutes per night), and had higher rates of insomnia, excessive daytime sleepiness, and snoring.

Comment

This is a good descriptive study of RLS in pregnancy. Although the prevalence is high in the months before delivery, by six months after delivery RLS has disappeared in women who did not have it before pregnancy.