From the Guidelines
Restless legs syndrome during pregnancy should be managed by first addressing exacerbating factors, such as alcohol, caffeine, and untreated obstructive sleep apnea, and ensuring adequate iron levels, as iron deficiency can worsen symptoms 1. The treatment of restless legs syndrome (RLS) in pregnancy is crucial to alleviate symptoms and improve quality of life.
Non-Medication Strategies
Some non-medication strategies that can be employed include:
- Regular moderate exercise
- Leg stretches before bedtime
- Maintaining a consistent sleep schedule
- Avoiding caffeine
- Warm baths, massage, and applying warm or cool packs to the legs may also provide relief.
Iron Supplementation
Ensuring adequate iron levels is essential, as iron deficiency can exacerbate RLS symptoms.
- Prenatal vitamins may provide sufficient iron, but additional supplementation may be recommended if ferritin levels are low, particularly if serum ferritin ≤ 75 ng/mL or transferrin saturation < 20% 1.
Medication
For severe cases that significantly impact sleep and quality of life, medication may be considered.
- However, many RLS medications are not recommended during pregnancy, and treatment decisions should always balance symptom relief with pregnancy safety 1.
- Some doctors may prescribe low doses of levodopa or clonazepam for short-term use in severe cases after discussing risks and benefits, although the American Academy of Sleep Medicine suggests against the standard use of levodopa and clonazepam due to low certainty of evidence and potential for augmentation 1. It is essential to consult with a healthcare provider before starting any treatment, as they can provide personalized recommendations based on the specific situation and pregnancy stage.
Pregnancy-Specific Considerations
RLS is common in pregnancy, and prescribers should consider the pregnancy-specific safety profile of each treatment being considered 1. Treatment decisions should prioritize both symptom relief and pregnancy safety, and healthcare providers should use clinical knowledge and experience to determine the best course of action, taking into account the individual patient's values and preferences 1.
From the Research
Treatment Options for Restless Legs in Pregnancy
- Nonpharmacologic methods are the primary recommended form of treatment for RLS in pregnancy and lactation 2
- Iron supplementation may be considered when the serum ferritin is low 2, 3, 4
- Medications with a more extensive safety record in pregnancy include opioids, antiepileptics, and certain benzodiazepines 3
- Dopamine agonists, such as pramipexole and ropinirole, are not currently recommended for use during pregnancy due to limited information on teratogenic risks 3
Diagnosis and Management
- Diagnosis of RLS in pregnancy involves a thorough history and examination, and iron measures, including ferritin and transferrin saturation, should be checked at presentation and with worsened symptoms 5
- Evaluation of iron status with measurement of serum ferritin is an integral part of a treatment plan for RLS in pregnancy 3, 4
- Nonpharmacologic approaches, including reassurance, exercise, and avoidance of exacerbating factors, are recommended 4
Considerations for Treatment
- Consideration of medical treatment for RLS during pregnancy should be balanced between the benefit of relieving symptoms and maternal and fetal risk 6
- Medications for RLS are risk/benefit rated for use during pregnancy and lactation, and some may be considered when RLS is refractory to more conservative approaches 4