Restless Legs Syndrome Affects One in Ten Third-Trimester Pregnancies in North Wollo
Restless legs syndrome affected 11.61% of third-trimester pregnant women attending antenatal care in public hospitals in North Wollo Zone, Ethiopia, placing the symptom burden squarely inside routine maternal care rather than at the margins of obstetric practice. The finding matters because RLS is not simply a nighttime nuisance; in pregnancy, the condition can fragment sleep, intensify fatigue, and deepen the strain on women already carrying the physiologic load of late gestation. In this cohort, the pattern was tied to several maternal and behavioral factors, including urban residence, gestational age of 37 weeks or more, history of abortion, iron supplementation, and alcohol use during pregnancy.
One out of ten women in late pregnancy reported a syndrome that often goes unrecognized in antenatal clinics.
The study enrolled 422 eligible third-trimester pregnant women with a 100% response rate, using systematic random sampling across public hospitals in the North Wollo Zone. Data collection ran from November 7, 2023, to February 7, 2024, and combined interviewer-administered questionnaires with chart review. Statistical analysis used bivariable and multivariable logistic regression, with significance defined at a p-value below 0.05. The design cannot prove causality, but it does provide a clear snapshot of symptom burden in a setting where local prevalence data have been sparse.
Late Gestation Carries the Heaviest Symptom Load
The association with gestational age was strong: women at 37 weeks or later had markedly higher odds of RLS than those earlier in the third trimester, with an adjusted odds ratio of 7.789 and a 95% confidence interval of 3.027 to 20.039. The biological explanation is plausible. Late pregnancy is a period of expanding blood volume, increasing iron demands, mechanical discomfort, and sleep disruption, all of which can amplify the sensory dysregulation and motor restlessness that define the syndrome. As the uterus enlarges and nocturnal sleep becomes more fragmented, even mild leg discomfort may become clinically consequential.
Urban residence also emerged as a significant correlate, with an adjusted odds ratio of 5.781 and a 95% confidence interval of 1.172 to 28.501. The study did not map the specific drivers of that difference, but urban living may track with differences in health-seeking behavior, diet, stress exposure, or recognition of symptoms during antenatal visits. The wide confidence interval signals statistical imprecision, yet the signal remained significant and should not be dismissed as noise.
History of abortion was another factor associated with RLS, with an adjusted odds ratio of 2.381 and a 95% confidence interval of 1.081 to 5.246. The underlying pathway is not established by this study, but prior reproductive history may mark broader vulnerability in maternal health, hematologic status, or psychosocial stress. In practical terms, obstetric history belongs in the same clinical conversation as current sleep complaints when pregnant women describe persistent leg discomfort at night.
Iron Supplementation Pointed Toward Lower Risk
Iron supplementation showed a protective association. Women taking iron had lower odds of RLS, with an adjusted odds ratio of 0.267 and a 95% confidence interval of 0.094 to 0.754. That finding fits the long-standing relationship between RLS and iron biology. Iron is central to dopamine metabolism and neural signaling in pathways implicated in movement regulation and sensory discomfort; when maternal iron stores are strained during pregnancy, symptoms may become easier to trigger and harder to ignore. The data support a bedside message that is already familiar in maternal health: recommended iron supplementation should not be treated as a formality.
Alcohol use during pregnancy was linked to higher odds of RLS, with an adjusted odds ratio of 2.289 and a 95% confidence interval of 1.049 to 4.995. The mechanism was not explored, but alcohol can disturb sleep architecture and aggravate nocturnal restlessness, making symptom perception more intense and more persistent. In a condition already intertwined with poor sleep, this exposure deserves direct counseling rather than vague caution.
Why the Symptom Burden Matters in Maternal Care
RLS during pregnancy has consequences that reach beyond discomfort. Sleep disruption can compound fatigue, impair concentration, and worsen emotional distress during a period when women are already vulnerable to mood symptoms. Prior work cited in the article links RLS in pregnancy to maternal anxiety, depression, pregnancy-induced hypertension, gestational diabetes, preterm birth, miscarriage, and low birth weight. Those outcomes were not measured in this cross-sectional study, but they frame why routine symptom inquiry has clinical weight. If antenatal care is meant to detect modifiable risk, nighttime leg restlessness belongs on the checklist.
The condition also tends to be underdiagnosed. Patients often describe sensations such as tingling, burning, itching, or crawling more readily than they use the label “restless legs syndrome,” and busy antenatal visits can easily miss that distinction. Because symptoms intensify at rest and often peak at night, women may normalize them as an unavoidable part of pregnancy. The result is familiar in many settings: a treatable problem stays unnamed until sleep loss and exhaustion have already accumulated.
What Antenatal Clinics Can Do Now
The findings support a straightforward clinical response. Pregnant women in late gestation, especially those nearing term, should be asked directly about nocturnal leg discomfort and urge-to-move symptoms. Iron supplementation deserves reinforcement, not only for anemia prevention but also for its potential relationship to RLS burden. Alcohol counseling should remain explicit during pregnancy, since its association with the syndrome adds another reason to discourage use.
The study was conducted in public hospitals in North Wollo Zone, with six hospitals contributing participants, including Woldia Comprehensive Specialized Hospital, Lalibela General Hospital, and four primary hospitals. The setting gives the results local relevance, but it also limits how widely the prevalence estimate can be generalized. Cross-sectional data capture association, not direction of effect, and the study relied on questionnaire-based symptom assessment rather than objective sleep or neurologic testing. Even so, the sample was complete, the methods were clearly defined, and the signal is strong enough to justify routine attention in antenatal practice.
For clinicians, the message is practical: ask about restless legs before sleep loss becomes an accepted part of late pregnancy. For health systems, the task is even simpler—make sure iron support reaches pregnant women, and do not let a common neurologic sleep complaint remain invisible inside maternal care.