Restless legs syndrome

Some women develop restless legs syndrome in pregnancy, usually in the third trimester. This can’t be treated with medication, but there are some things you can do to try to ease the symptoms.

What is restless legs syndrome?

Restless legs syndrome, also known as Willis-Ekbom disease, is a common condition of the nervous system that causes an overwhelming irresistible urge to move your legs.

What are the symptoms of restless legs syndrome?

The main symptom is the overwhelming urge to move your legs. But you may also have uncomfortable and unpleasant sensations in your legs. Some people describe these as:

  • tingling
  • burning
  • itching
  • a ‘creepy-crawly’ sensation, like ants moving up and down the legs
  • like fizzy water in the veins.

These sensations are often worse just below the knee and can sometimes be painful.

Your symptoms may be worse when you’re resting and may feel better when you move. They may be worse in the evening or at night.

Restless legs syndrome can be very frustrating, but it should not affect your health or pregnancy. However, it can make it more difficult to get a good night’s sleep.  A lack of sleep won’t hurt your baby, but it can make your day-to-day life a bit more difficult. We have some tips that may help you sleep better.

Restless legs syndrome caused by pregnancy usually develops during the third trimester (the last 3 months of pregnancy). At this point, sleeping on your side is the safest thing to do for your baby because research shows it can reduce the risk of stillbirth.

How is restless legs syndrome diagnosed?

Unfortunately, there isn’t a test that can confirm whether you have restless legs syndrome. Instead, your doctor or midwife will talk to you about your symptoms and medical history.

What causes restless legs syndrome?

Sometimes the cause for restless legs syndrome is not known. These cases are known as idiopathic.

Pregnancy

About 20% of pregnant women develop restless legs syndrome, usually in the third trimester. This is possibly caused by a change in hormones.

Iron-deficiency anaemia

Anaemia (a blood condition) can sometimes cause restless leg syndrome and iron-deficiency anaemia can be common in pregnancy.  

You’ll be checked for anaemia as part of your routine antenatal care, but you can have a test at any time during your pregnancy if there are any concerns.

If you have anaemia, you’ll probably be prescribed iron supplements as tablets or as a liquid to take every day. Eating a healthy, balanced diet will also help you get the iron you need to either prevent anaemia or manage your symptoms if you have it.

Other conditions

There are some conditions that may cause restless legs syndrome, although the scientific research to prove this is limited. These include:

  • neurological conditions, such as Parkinson’s disease and multiple sclerosis
  • rheumatoid arthritis
  • diabetes 
  • hypothyroidism
  • a very high BMI (body mass index)

Some medications

Some medications can cause restless legs syndrome or make it worse, including

  • antidepressants
  • some antipsychotics and lithium
  • some antiepileptic drugs
  • antihistamines
  • dopamine receptor blocking agents such as metoclopramide and prochlorperazine
  • beta-blockers.

But it’s important not to stop taking any medications without speaking to your doctor first.

Diet

There is also a theory that drinking excessive amounts of alcohol, caffeine, or eating too much chocolate can cause restless legs syndrome.

There isn’t enough scientific evidence to prove this is true. But we know for certain that drinking alcohol in pregnancy can cause serious complications in pregnancy. The more you drink, the greater the risk. There is no known safe level for drinking during pregnancy, so the safest approach is not to drink at all while you're pregnant.

Caffeine is found in coffee, tea, some soft drinks, energy drinks and chocolate. Drinking a lot of caffeine in pregnancy has also been linked to miscarriage and low birth weight so the advice is to limit your intake to 200mg a day. You can check your caffeine intake with our pregnancy caffeine calculator.

What is the treatment for restless legs syndrome during pregnancy?

Medication isn’t generally recommended during pregnancy or while you are breastfeeding. But there are other things you can try. You may not be able to stop the symptoms completely, but you may be able to reduce them.

As well as reducing your caffeine intake and not drinking alcohol, you can try:

  • stopping smoking (this can also reduce the risk of serious pregnancy complications)
  • doing moderate, regular exercise (such as swimming)
  • walking and stretching your legs
  • relaxation exercises
  • using heat pads on the legs, or having a hot bath
  • using distraction techniques, such as reading
  • massaging the legs.

Will restless legs syndrome go away after I give birth?

Yes. If your symptoms are caused by pregnancy, it’s likely that they will go away soon after giving birth. Unfortunately, women who have restless legs syndrome during pregnancy have an increased risk of developing the syndrome in later life.

Other conditions with similar symptoms to restless legs syndrome

Blood clots

The symptoms of restless leg syndrome can sometimes be confused with the symptoms of blood clots (deep vein thrombosis). However, they are different problems.

Deep vein thrombosis (DVT) can happen for no apparent reason, but you are more at risk during pregnancy and just after having your baby.

Call 111 or arrange an urgent appointment with your GP if you have these symptoms in your leg:

  • throbbing or cramping pain in 1 leg (rarely both legs), usually in the calf or thigh
  • swelling in 1 leg (rarely both legs)
  • warm skin around the painful area
  • red or darkened skin around the painful area
  • swollen veins that are hard or sore when you touch them

These symptoms also happen in your arm or tummy if that's where the blood clot is.

Your risk of developing DVT during pregnancy is even greater if you:

Call 999 or go to your nearest A&E if you have any of these symptoms, with chest pain or breathlessness. This may mean that the DVT has travelled to your lungs, which can be life threatening.

Staying as active as you can during pregnancy can help reduce the risk of a DVT.

Meralgia paraesthetica

Another condition that can cause uncomfortable or painful feelings in the leg is meralgia paraesthetica. This is a common problem caused by a trapped nerve in the thigh. The most common cause for this is recent weight gain or pregnancy. This causes a painful patch of burning, numbness or pins and needles on the outer side of the thigh (although the affected area can vary from person to person). This should get better after pregnancy but talk to your GP or midwife if you have this kind of pain. 

Sources

Clinical Knowledge Summaries. Restless legs syndrome https://cks.nice.org.uk/restless-legs-syndrome (Last updated December 2016 Next update due December 2020)

Heazell AEP, Li M, Budd J, Thompson JMD, Stacey T, Cronin RS, Martin B, Roberts D, Mitchell EA, McCowan LME. Association between maternal sleep practices and late stillbirth – findings from a stillbirth case-control study. BJOG2017; https://doi.org/10.1111/1471-0528.14967.

NHS Choices. Restless legs syndrome. https://www.nhs.uk/conditions/restless-legs-syndrome/ (page last reviewed 06/08/2018 Next review due 06/08/2021)

NHS Choices. Iron deficiency anaemia. https://www.nhs.uk/conditions/iron-deficiency-anaemia/ (Page last reviewed: 12/01/2018 Next review due: 12/01/2021)

Royal College of Obstetricians & Gynaecologists (2015) Alcohol in pregnancy https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-alcohol-and-pregnancy.pdf

NHS Choices. Deep vein thrombosis (DVT) in pregnancy https://www.nhs.uk/conditions/pregnancy-and-baby/dvt-blood-clot-pregnant/ (Page last reviewed: 27/03//2018 Next review due: 27/03/2021)  

Patient. Meralgia Paraesthetica https://patient.info/doctor/meralgia-paraesthetica-pro (Page last reviewed 24/02/2017 Next review due 23/02/2022)

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    Last reviewed on June 5th, 2020. Next review date June 5th, 2023.

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