Restless legs syndrome during pregnancy and puerperium

Pregnancy is a significant risk factor for the development of restless legs syndrome (RLS). Apart from its negative impact on sleep and general quality of life, RLS is also associated with pregnancy complications and negative outcomes. To elucidate the prevalence, trajectory, severity, and risk factors of RLS throughout pregnancy and the postpartum period, we analyzed data from the multicenter Life-ON Cohort Study (NCT02664467), which recruited 439 pregnant women in the 10th-15th gestational week and followed them up until 12 months after delivery. About 26.03% of women (n = 113, 95% CI = 22.0% to 30.4%) met the diagnostic criteria for RLS in at least one of the three visits during pregnancy. RLS severity was similar during all trimesters and during the postpartum period with however higher values in women who screened positive for RLS in all the three or two trimesters compared to those who screened positive in just one. A previous history of RLS was found in 50.68% of women who reported RLS during the current pregnancy and 18.7% had a positive family history. During the entire follow-up period out of 386 women, 134 were diagnosed with RLS, corresponding to a cumulative incidence of 34.7%. Previous history of depression, positive family history for RLS and previous RLS were statistically significant risk factors for RLS during pregnancy. Around 20% of women experienced severe to very severe symptoms (IRLS >20 pts), representing a possible target to be carefully considered for a pharmacological treatment. A systematic screening approach and treatment of eligible women could greatly improve quality of life and reduce comorbidity during pregnancy. Statement of Significance In this secondary analysis, we aimed to track the natural progression of RLS during pregnancy and after delivery, using data from the Life-ON Cohort Study. The study found that 26.03% of pregnant women experienced restless legs syndrome (RLS) with 20% of those reporting moderate/severe symptom intensity (IRLS >20). Those findings underline the high prevalence of RLS during pregnancy with the new finding of relative symptom-stability independent of the trimester of pregnancy and 1 in 5 patients exhibiting severe to very severe symptoms. The correct identification and treatment of RLS during pregnancy could potentially greatly improve womens' sleep quality and generally quality of life during pregnancy and reduce associated pregnancy complications and negative pregnancy outcomes.