Restless Legs in Pregnancy: The 22% Problem Nobody Screens For

One in five pregnant women has restless legs syndrome. Most are never diagnosed. The treatment starts with a blood test your doctor probably is not ordering.

Here is something that should bother every obstetrician: restless legs syndrome affects 22% of pregnant women, roughly one in five pregnancies (1). It wrecks sleep during the trimester when sleep matters most. It has a known, treatable cause in most cases.

And almost nobody screens for it.

Instead, when a pregnant patient says she cannot sleep because her legs will not stop moving, the typical response is a recommendation for diphenhydramine (Benadryl). That recommendation may be making the problem worse, because antihistamines are one of the medications known to trigger or worsen restless legs syndrome (2).

What Is Restless Legs Syndrome?

Restless legs syndrome (RLS) causes an overwhelming urge to move the legs, usually accompanied by unpleasant sensations: tingling, aching, a creepy-crawly feeling, or what patients often describe as “soda bubbling in the veins.” The symptoms appear at rest, improve with movement, and are worst in the evening and at night (3). For pregnant women already dealing with back pain, frequent urination, and anxiety, RLS can make sleep nearly impossible.

Patients with RLS take at least 30 minutes to fall asleep, and 60% wake three or more times per night (4). Sleep efficiency drops from about 84% in healthy adults to 75% in patients with RLS (5). In pregnancy, where baseline sleep quality is already compromised, these numbers translate into real suffering.

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