Gestational Restless Leg Syndrome: In the Spotlight

Prim Care Companion CNS Disord 2023;25(1):22br03235

To cite: Naguy A, Alamiri B. Gestational restless leg syndrome: in the spotlight. Prim Care Companion CNS Disord. 2023;25(1):22br03235.
To share: https://doi.org/10.4088/PCC.22br03235

© 2023 Physicians Postgraduate Press, Inc.

^aDepartment of Child/Adolescent Psychiatry, Al-Manara CAP Centre, Kuwait Centre for Mental Health, Shuwaikh, Sulibikhat, Kuwait
^bDepartment of Psychiatry, Al-Manara CAP Centre, Kuwait Centre for Mental Health, Shuwaikh, Sulibikhat, Kuwait
^cTufts University, Medford, Massachusetts
*Corresponding author: Ahmed Naguy, MBBCh, MSc, Department of Child/Adolescent Psychiatry, Al-Manara CAP Centre, Kuwait Centre for Mental Health, Jamal Abdul-Nassir St, Shuwaikh, Sulibikhat 21315 Kuwait ([email protected]).

Restless leg syndrome (Ekbom syndrome) is more frequently seen in women compared to men, with parity accounting for the majority of 2:1 gender difference reported.¹ It commonly occurs de novo or gets worse during pregnancy. When confined exclusively to pregnancy, it has been designated gestational restless leg syndrome (gRLS).

Women with gRLS often have a family history of RLS and are at a heightened (4-fold) risk of developing chronic RLS. Other risk factors for gRLS include smoking, snoring in the first trimester, obesity, prior history of RLS, or gRLS in previous pregnancies.²

Dopaminergic dysregulation in basal ganglia has been posited to be at the core of the etiopathophysiology of RLS. Also, dysregulation of transferrin receptors on tyrosine hydroxylase neurons has been postulated.³ gRLS has been tied to hormonal factors (higher estradiol levels, hence more prevalent during the third trimester), metabolic factors (higher demands for iron and folate in pregnancy), and psychological factors (stress, fatigue, and insomnia commonly seen in pregnancy).³

Diagnosis of gRLS is chiefly clinical. The working differential in pregnancy should entail leg cramps, neuropathies, venous stasis, drug akathisia, and anxiety.⁴ It has been noted that gRLS increases the risk for a few pregnancy-related comorbidities, including inter alia, preeclampsia, and preterm labor.⁵ While gRLS tends to remit in most women during the postpartum period, 10% of cases remain unchanged or worsen.⁶

Nonpharmacologic interventions are generally preferred. Avoidance of potential triggers is strongly recommended, eg, caffeine, alcohol, tobacco, prolonged immobility, and serotonergic agents. Yoga, massage, exercising, and relaxation techniques are all encouraged. Iron supplementation is indicated to raise levels of serum ferritin ˃ 75 µg/L. In some cases, when all else fails, low-dose pramipexole (in pregnancy) or gabapentin (postpartum) can be cautiously used.⁶

Submitted: January 2, 2022; accepted March 14, 2022.
Published online: January 19, 2023.
Relevant financial relationships: None.
Funding/support: None.