RESTLESS LEG SYNDROME (RLS), MORE RECENTLY RENAMED WILLIS-EKBOM DISEASE, IS A CONDITION THAT DISRUPTS SLEEP AND OCCURS MORE FREQUENTLY IN THE PREGNANT WOMEN. PREGNANCY IS LISTED AS A RISK FACTOR FOR DEVELOPING THE RLS. THE PREVALENCE OF RLS DURING PREGNANCY IS AROUND THREE TIMES GREATER THAN IN THE GENERAL POPULATION AND IT IS EVEN MORE SEVERE DURING THIS TIME AND IT COULD HAVE A NEGATIVE IMPACT ON QUALITY OF LIFE AND THE COURSE OF PREGNANCY AND/OR LABOR. SYMPTOMS ARE PARTICULARLY STRONG AND FREQUENT DURING THE THIRD TRIMESTER OF PREGNANCY AND DISAPPEAR AROUND LABOR. A PRE-EXISTING FORM OF RLS TENDS TO WORSEN DURING PREGNANCY. PREGNANT WOMEN WHO EXPERIENCE RLS HAVE A HIGHER RISK OF SYMPTOMS IN FURTHER PREGNANCIES AND OF DEVELOPING A PRIMARY FORM OF RLS LATER IN LIFE, THAN WOMEN FREE OF SYMPTOMS DURING PREGNANCY. RLS IS A CONDITION OF UNPLEASANT LEG SENSATIONS THAT TYPICALLY OCCUR PRIOR TO SLEEP ONSET AND CAUSE AN ALMOST IRRESISTIBLE URGE TO MOVE THE LEGS. MOVEMENT OF THE AFFECTED LIMBS OFTEN ABOLISHES THE DISCOMFORT OR RELIEVES THE URGE TO MOVE THE LEGS WHILE BEING AT REST. THERE ARE WORSE IN EVENING. WHEN RLS OCCURS DURING PREGNANCY, IT IS CLASSIFIED AS TRANSIENT OR SECONDARY RLS. ALTHOUGH UNLIKELY, A PATIENT COULD HAVE IDIOPATHIC RLS THAT IS NOTED FIRST DURING PREGNANCY BUT THAT IS UNCOMMON. SECONDARY RLS IS ASSOCIATED WITH IRON DEFICIENCY, FOLATE DEFICIENCY, PERIPHERAL NEUROPATHY, END-STAGE RENAL DISEASE, PREGNANCY, PARKINSON’S DISEASE, RHEUMATOID ARTHRITIS, FIBROMYALGIA, AND SEVERAL OTHER RARE CAUSES. CURRENT EVIDENCE SUGGESTS THAT DOPAMINERGIC INSUFFICIENCY, IMPAIRED IRON HOMEOSTASIS IN THE CENTRAL NEURONS, HORMONAL CHANGES SUCH AS ESTROGEN, PROGESTERONE AND PROLACTIN AND GENETIC PREDISPOSITION MAY BE INVOLVED IN THE PATHOPHYSIOLOGY OF RLS,, ALTHOUGH THE MOST CONSISTENT DATA RELATE TO IRON. RLS IS A CLINICAL DIAGNOSIS WITH WELL-ESTABLISHED DIAGNOSTIC CRITERIA AND A SLEEP STUDY IS NOT REQUIRED. LABORATORY EVALUATION RECOMMENDATIONS INCLUDE IRON PANEL, FOLATE, VITAMIN B12, THYROID FUNCTION, ANEMIA INDEXES, GLYCEMIC RESPONSE, AND RENAL FUNCTION THE FIRST-LINE TREATMENTS ARE MOSTLY BEHAVIORAL/ NON-PHARMACOLOGICAL. FOR SEVERE CASES, A FEW PHARMACOLOGIC OPTIONS MIGHT BE CONSIDERED IF USED CAUTIOUSLY, ALTHOUGH NO DRUGS CURRENTLY HAVE A SPECIFIC INDICATION FOR RLS DURING PREGNANCY. THESE MAINLY CONSIST OF MEASURES TO CONTAIN SYMPTOMS AND AVOID AGGRAVATING FACTORS. RLS IS NOT WELL KNOWN AMONG PHYSICIANS AND PATIENTS AND SHOULD BE DIVULGED BY EDUCATIONAL PROGRAMS, ESPECIALLY FOR PREGNANT WOMEN. TREATMENT OF RLS IS USUALLY TO SUPPLEMENT IRON AND FOLATE. THE CONSENSUS GUIDELINES RECOMMEND TO CONSIDER IRON SUPPLEMENTATION IN RLS-AFFECTED PREGNANT WOMEN IF FERRITIN LEVELS ARE LESS THAN 75 MG/L. ALTHOUGH DOPAMINE AGONISTS, ROPINIROLE AND PRAMIPEXOLE, ROTIGOTINE, HAVE BEEN APPROVED BY THE FDA FOR THE TREATMENT OF RLS AND ARE CURRENTLY THE FIRST-LINE TREATMENT FOR DAILY SYMPTOMS, THERE IS VERY LITTLE INFORMATION ON THE TERATOGENIC RISKS OF THESE NEW MEDICATIONS. THEREFORE, THEY ARE NOT CURRENTLY RECOMMENDED FOR USE DURING PREGNANCY. MEDICATIONS WITH A MORE EXTENSIVE SAFETY RECORD IN PREGNANCY INCLUDE OPIOIDS; ANTIEPILEPTICS, SUCH AS CARBAMAZEPINE AND GABAPENTIN; AND CERTAIN BENZODIAZEPINES. RULING OUT IRON DEFICIENCY SHOULD BE AN INTEGRAL PART OF A TREATMENT PLAN FOR RLS IN PREGNANCY. BUT BEFORE MANAGEMENT WITH MEDICATION IS INTRODUCED, EVERY PATIENT SHOULD BE ASSESSED FOR IRON STATUS WITH MEASUREMENT OF SERUM FERRITIN.