Restless legs syndrome (RLS) — an uncomfortable, often overwhelming urge to move the legs, typically worse at rest and in the evening — is a common but frequently overlooked complication of pregnancy. A new systematic review and meta-analysis published in Health Science Reports puts a firm number on just how common it is: pooling data from 19 studies and more than 48,000 pregnant women worldwide, the researchers, led by Nader Salari, calculated a global prevalence of 21.9%.
Nearly One in Three by the Third Trimester
The prevalence wasn't static across pregnancy. Broken down by trimester, RLS affected 31.6% of women in the first trimester, dipped slightly to 22% in the second, and climbed to 34.2% by the third trimester — meaning roughly one in three pregnant women were experiencing restless legs symptoms as they approached delivery.
Geography mattered too. Prevalence estimates varied widely by continent: 19.2% in Asia, 22.4% in Europe, 19.9% in the Americas, and a striking 58.1% in Africa, though the authors caution that fewer studies were available from African cohorts, which can widen uncertainty in regional estimates.
An Underrecognized Symptom With a Biological Basis
RLS in pregnancy is believed to stem from a combination of factors that shift as pregnancy progresses: expanding blood volume and iron demands that can tip women toward iron deficiency even without overt anemia, hormonal changes involving estrogen and progesterone that influence dopaminergic signaling in the brain, and increased folate turnover. Iron and dopamine dysfunction are both central to current models of RLS pathophysiology outside of pregnancy as well, but pregnancy's physiological demands appear to intensify the risk.
Despite how common it is, RLS in pregnancy is easy to miss or dismiss. Many pregnant women attribute leg discomfort to normal pregnancy-related swelling, cramping, or general discomfort, and RLS is not part of routine prenatal screening in most care settings. That gap matters because RLS during pregnancy is associated with worse sleep quality, and some research has linked it to higher rates of depressive symptoms and reduced quality of life during an already physically demanding period.
What This Means for Patients
Pregnant women experiencing an urge to move their legs that worsens in the evening or at rest, and improves with movement, should mention it to their obstetric provider rather than assuming it is an unavoidable part of pregnancy. Given the tie between RLS and iron status, a ferritin check is often a reasonable first step, since correcting iron deficiency can meaningfully improve symptoms in some cases without the need for medication.
For clinicians, this meta-analysis reinforces that RLS is common enough in pregnancy — particularly by the third trimester — to warrant routine screening as part of standard prenatal sleep and comfort assessments, rather than waiting for patients to raise it unprompted. Most pregnancy-related RLS resolves after delivery, but for the many women affected in the meantime, recognizing and addressing it can meaningfully improve sleep quality during the final stretch of pregnancy.
