When does restless legs start in pregnancy

Heartburn and nausea are well-known side effects of pregnancy. But did you know restless legs syndrome is too? About one-third of pregnant women experience crawly, tingling sensations in their legs, a hallmark of the disorder. But there are natural ways to tame RLS symptoms during pregnancy...If you’re pregnant, morning sickness may not be your only problem.You could also be at higher risk for restless legs syndrome (RLS), a neurological condition characterized by painful, crawling sensations in the legs and an irresistible urge to move them. RLS affects 10% of women and up to 40% of pregnant women, making it the most common problem in pregnancy, according to a 2010 study by the University of Michigan.Your genes, hormones and an iron deficiency could be culprits.“Pregnant women need 3-4 times more iron than usual to nourish the developing fetus and are at higher risk for symptoms of iron deficiency – a major cause of RLS,” says Mark Buchfuhrer, M.D., an internist and pulmonary specialist at SomnoMedix Sleep Disorders Center in the Los Angeles area and coauthor of Restless Legs Syndrome: Coping With Your Sleepless Nights (Demos Medical Publishing).That's because iron deficiency may disrupt dopamine, a brain neurotransmitter that controls muscle activity and movement, explains Jeffrey Durmer, Ph.D., M.D., a sleep medicine doctor, researcher and chief medical officer of FusionHealth & FusionSleep near Atlanta, Ga.Higher levels of estradiol (the main type of estrogen hormone in women) during pregnancy could also be a factor, according to a 2009 study conducted in Munich, Germany. It found that pregnant women with RLS had higher estradiol levels than women without the condition.

So what are the odds that you'll suffer from restless legs syndrome?“If you have a genetic predisposition to RLS but never had symptoms until your last trimester of pregnancy, RLS will probably go away within three months after delivery,” says midwife Jennifer Hensley, R.N., coordinator of nurse-wifery at the University of Colorado College of Nursing in Denver, and part of the International Restless Legs Syndrome Study Group (IRLSSG), which is setting guidelines for treating RLS during pregnancy.“If you already had RLS when you got pregnant, symptoms are likely to worsen in pregnancy and get progressively worse with each pregnancy,” she says.In addition, “most RLS medications have not been proven safe in pregnancy, so women must rely on non-medical therapies and treatments,” says Kartha Ninth, M.D., a neurologist and chair of the Movement Disorder Clinic at Loyola Health System outside Chicago.Fortunately, you have safe, natural ways to combat RLS symptoms during pregnancy. Read on for 7 ways to keep RLS symptoms at bay.1. Get enough iron (and folic acid).
Pregnant women need 3-4 times more iron and 8-10 times more folate to nourish the developing fetus.Pregnant women with restless legs syndrome have decreased iron stores in their cerebrospinal fluid, according to a 2007 study at Durango Natural Medicine in Colorado, which analyzed research on more than 35,000 patients with RLS. They were also deficient in folate, a B vitamin that helps produce healthy red blood cells, the study found.Fortunately, most pregnant women can easily correct iron and folate deficiencies by taking supplements, Ninth says.In the study, just 9% of women who took iron and folate supplements during pregnancy suffered RLS symptoms, compared with 80% of women who didn’t take them.

How much is enough?The IRLSSG recommends taking 325 milligrams (mg) of ferrous sulfate (iron supplements) daily with 250-500 mg of vitamin C on an empty stomach (vitamin C aids the absorption of iron) plus 1,000 micrograms (mcg) of folate, found in many prenatal vitamins.“Get your iron and folic acid levels checked as soon as you get pregnant and then every month for the next three months,” Hensley says. “Don’t continue taking iron if you don’t need it, because it could lead to iron toxicity, which could interfere with your baby’s development."2. Go into pregnancy at an ideal weight.
Women who are obese or have excess belly fat before pregnancy are at higher risk of developing restless legs syndrome, according to a 2009 Harvard study conducted on more than 80,000 people with RLS.“Women used to think they needed to gain 25-35 pounds during pregnancy, but 5 pounds is enough, says Brad Douglas, an OB-GYN with St. Mary’s Hospital in Richmond, Va."If you’re already overweight or obese, you shouldn’t gain any weight, especially if you have RLS.”

Vitamin B12 may support the stability of nerve fibers, preventing excessive sensitivity and decreasing RLS symptoms, according to a 2008 review study conducted at Tottori University in Japan.Other vitamins that may help reduce symptoms include vitamin C and vitamin D, according to Tottori University.Besides popping vitamins, you should eat a healthy diet with lots of iron-rich foods (dark green vegetables, liver, wheat germ, kidney beans and lean beef) and foods high in vitamin C (citrus fruits, fortified cereals, papayas and grains, the IRLSSG says).4. Get off your butt.
Women with restless legs syndrome who don’t exercise have worse RLS symptoms than those who do, according to the 2011 review study conducted by Brigham Young University.In the study, women who engaged in aerobic and lower-body resistance training three times a week had fewer RSL symptoms than couch potatoes. Exercise reduced RLS pain by releasing feel-good endorphins and increasing blood flow to muscles, the study found.But how you exercise makes a difference.“Avoid overly strenuous exercise, especially if you’ve never done it before, which can aggravate symptoms by irritating and inflaming leg tissues,” says Donald Watenpaugh, Ph.D., director of Sleep Consultants in Fort Worth, Texas, and an RLS sufferer.

“When you’re pregnant, stick to low-impact exercises, like walking and water aerobics, and avoid high-impact activities like running,” advises Michelle Bommarito, a Los Angeles-based certified fitness instructor and personal trainer who works with RLS sufferers.“If you’re taking low-impact aerobics classes, start with 15 minutes and gradually work up to an hour over six months,” Bommarito says.Stretching is also essential, at bedtime and when you get up, Buchfuhrer says."Stretch your legs to their full length and point your toes," he advises.If this doesn’t help relieve RLS symptoms, take a brief walk around your home, taking long steps and bending your legs to stretch muscles,” he says.Also try yoga, Bommarito suggests.“Gentle types of yoga, such as Hatha and Anusara, are also great ways to stretch your leg muscles,” she says.But avoid strenuous types of yoga, such as Ashtanga and Vinyasa, which could trigger a flare, she says.

5. Be savvy about medications.
“All women with RLS, and especially pregnant women, should avoid most antihistamines, most antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic drugs, and most anti-nausea drugs, cold, flu and allergy meds,” Buchfuhrer says.That's because many of these drugs can block dopamine levels and exacerbate RLS symptoms, he explains.For a list of safe and unsafe drugs during pregnancy, visit the RLS Foundation at rls.org.6. Get a massage.
Massage may also help alleviate symptoms of restless legs syndrome, especially when pressure is directly applied to the legs, according to the 2011 Brigham Young University study.Patients with RLS who received Swedish massage twice a week for three weeks enjoyed relief from symptoms for two weeks after this RLS treatment, according to the study.To do it yourself, “sit on the edge of the bed and firmly rub or massage your calves to give the muscles deeper stimulation,” Buchfuhrer says.7. Relax and go with the flow.
Patients with RLS who prayed, meditated or listened to relaxing music regularly enjoyed a temporary reduction in symptoms, according to the 2008 Japanese study at Tottori University.