Understanding Restless Leg Syndrome During Pregnancy

Introduction:

There are many conditions and symptoms mothers face during pregnancy, the major cause of these are insufficient sleep and frequent awakening. Restless leg syndrome in pregnancy is a very common clinical condition. Although pregnancy is the main causing factor behind this, the exact cause of the condition is not known. The severity of the condition varies from person to person. A more severe case can further create complications during childbirth. Usually, the RLS worsens during the last months of pregnancy and gets resolved independently after the delivery.

What Is a Restless Leg Syndrome?

RLS is also known as Aka Willis-Ekbom syndrome. It is seen in 20 percent of the population of pregnant women. The urge to shake the legs can also similarly occur in other body parts. The condition worsens when a person is resting, especially during the evening and at night. Patients often experience a lack of sleep during such conditions. The most common environmental factor which can trigger RLS is iron deficiency. This impairs the neuron activity in the brain leading to oxygen depletion in the body.

What Causes Restless Leg Syndrome?

There is no known cause for RLS. Studies believe that certain imbalances in the brain chemicals, such as dopamine, are responsible for RLS. The dopamine hormone helps in controlling muscle movements.

• Hereditary: Sometimes, RLS can be caused due to a familial history of a similar condition. Certain chromosomal abnormalities are linked to RLS dysfunction.

• Pregnancy: Various hormonal changes during pregnancy can cause RLS.

What Are the Signs and Symptoms of Restless Leg Syndrome?

One of the most common symptoms experienced is the urge to move the legs. Women who encounter RLS describe the following symptoms during pregnancy.

• The legs have an uncontrolled compelling sensation. It occurs on both legs.

• The condition worsens during nighttime. The symptoms worsen while lying, resting, or sitting positions for an extended period.

• The skin feels throbbing, itching, pulling, and crawling in sensation.

• Pain in the legs is present.

• The patient feels less pain while moving or stretching the body, like walking, pacing, or jiggling the legs.

• Occasionally, the patient may feel twitching or kicking of legs during sleep.

The symptoms of RLS are often misdiagnosed as muscle cramps or numbness of the feet. Sometimes the patient feels an absence of symptoms for a long period. The symptoms vary and become difficult to explain.

What Are the Risk Factors Associated With Restless Leg Syndrome?

RLS in pregnant women below the age of 40 showed greater incidence. Any previous history of RLS in childhood can also cause it to reoccur during pregnancy. It is more common in women than men. The risk of this condition increases with age. RLS can often lead to other conditions, such as:

• Peripheral Neuropathy: The continuous shaking of body parts, especially the legs, can cause damage to nerve cells and motor function.

• Iron Deficiency: Lack of iron content in the blood can worsen the condition. The patient may not show clinical signs of anemia but would lack the iron content in the blood. The body will circulate deoxygenated blood and thus can cause stress.

• Kidney Failure: Iron deficiency is often associated with kidney failure. Failure in kidney function can indicate low iron content in the blood. This can cause RLS.

• Spinal Cord Dysfunction: A spinal cord injury has a higher incidence of developing into RLS. Such as spinal anesthesia can cause trauma and induce RLS in women.

• Parkinson’s Disease: Patients suffering from a neurological condition like Parkinson’s disease take medications like dopaminergic agonists, which have an increased risk of developing into RLS.

What Are the Complications Seen in RLS?

RLS can lead to other complications if not managed properly, such as:

• Insomnia: It is a very common sleep disorder, where a person finds it difficult to fall asleep. There are many etiological factors affecting this such as anxiety, depression, lack of exercise, or some chronic illness.

• Depression: It is a mental disorder where a person has constant feelings of sadness or loss of interest.

• Difficulty during childbirth.

What Are the Treatment Options for Restless Leg Syndrome?

There is no specific treatment to treat RLS. Certain underlying conditions, like an iron deficiency in the blood, can be managed. This can help in relieving the symptoms. On a clinician’s observation, iron supplement tablets can be taken orally or intravenously. Periodic monitoring of the blood-iron level should be done.

• Medical Management: In severe cases, medicines are prescribed to control the condition. These medicines improved the restless activity in the leg. Medicine containing dopamine is used to control the abnormal activity of the brain. Drugs such as Rotigotine (Neupro) and Pramipexole (Mirapex) treat RLS. The Food and Drug Administration (FDA) approves it for treating RLS in both moderate and severe cases.

Do the Drugs Used in RLS Treatment Cause Any Side Effects?

Most drugs come with some side effects. There are some short-term side effects known with the use of RLS drugs. It includes:

• Mild nausea.

• Lightheadedness.

• Fatigue.

• Impulse control disorders like compulsive gambling and daytime sleepiness.

Certain long-term effects noted are as follows:

• Calcium Channel Blockers: Drugs like Gabapentin (Neurontin Gralise), Gabapentin enacarbil (Horizant), and Pregabalin (Lyrica) work for some people with RLS.

• Muscle Relaxants and Insomnia Medications: These drugs help relax the muscles but do not cure the shaking of the legs. As a result, it can cause daytime sleepiness. It is only done in cases where other medications fail.

• Opioids: It is used in severe cases. But these drugs can be narcotic, which means it has an addictive nature. For example, Tramadol (Ultram, ConZip), Codeine, Oxycodone (Oxycontin, Roxicodone), and Hydrocodone (Hysingla ER).

It takes a lot of clinical trials before finding the right drug combination showing results in patients. The treatment guidelines differ from patient to patient.

How Can RLS Be Managed?

If the RLS is not caused due to iron deficiency, then treatment should focus more on lifestyle changes. Non-pharmacological approaches like change in diet, exercise, counseling, and cessation of any habits which exacerbates the condition, like moving the legs unwantedly, should be strictly avoided.

Conclusion:

RLS accounts for about 29 percent of cases in pregnant women. RLS can be managed by bringing out lifestyle changes. The administration of drugs in RLS might be ineffective after some time of drug intake. The symptoms can reoccur and can be disturbing. Such repeated episodes of on-and-off symptoms are called augmentation. Involuntary jerking movement of the legs can be suppressed primarily by treating the underlying cause and by medications.