In a 37-year-old woman at 26 weeks gestation with pregnancy-related restless legs syndrome, what is the most likely prognosis if no treatment is provided?

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Last updated: September 27, 2026 • View editorial policy

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Pregnancy-Related RLS: Natural History and Prognosis

The symptoms are likely to worsen over the course of the pregnancy and remit after giving birth (Answer A).

Clinical Course of Pregnancy-Related RLS

The natural history of restless legs syndrome during pregnancy follows a predictable pattern that is well-established in the literature:

Symptom Progression During Pregnancy

  • RLS symptoms typically intensify as pregnancy advances, with symptoms being particularly strong and frequent during the third trimester 1
  • At 26 weeks gestation, this patient is entering the period when symptoms characteristically worsen
  • The prevalence increases from approximately 1.6% in the second trimester to 3.5% in the third trimester 2

Postpartum Resolution

The vast majority of pregnancy-related RLS resolves spontaneously after delivery:

  • 64.8% of women experience complete resolution of RLS symptoms after delivery 3
  • Among those who improve, half experience symptom resolution within 2 weeks of delivery 3
  • Symptoms typically disappear "around delivery" with complete remission soon after parturition 4, 1

Minority with Persistent Symptoms

While most cases resolve, a small subset continues postpartum:

  • Only 19.3% of women with pregnancy-related RLS remain affected 12 weeks postpartum 5
  • This represents the minority rather than the typical course

Important Clinical Caveats

Women who experience RLS during pregnancy face increased future risk:

  • Higher likelihood of RLS symptoms in subsequent pregnancies 1
  • Increased risk of developing primary RLS later in life compared to women without pregnancy-related symptoms 1

Pre-existing RLS behaves differently:

  • Women with RLS prior to pregnancy tend to experience worsening during pregnancy 1
  • This patient's presentation at 26 weeks with new-onset symptoms suggests pregnancy-induced rather than pre-existing disease

Clinical Implications

The favorable prognosis of pregnancy-related RLS (worsening until delivery, then rapid resolution) should inform counseling and treatment decisions. Given that symptoms will likely intensify over the next 14 weeks but resolve postpartum, conservative management with iron supplementation (if ferritin <75 ng/mL) and reassurance is often appropriate 6. The 2025 AASM guidelines specifically note that "RLS is common in pregnancy; prescribers should consider the pregnancy-specific safety profile of each treatment being considered" 6.

References

2
Research

Time-varying restless legs syndrome and risk of incident perinatal depression.

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2026

6
Guideline

treatment of restless legs syndrome and periodic limb movement disorder: an american academy of sleep medicine clinical practice guideline.

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2025

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