Postpartum Period With POTS

Applicable Questions and Answers Listed Below:

What will my postpartum period be like with POTS?

The postpartum period for all new parents can be quite challenging and isn’t talked about enough. There are social, cultural, environmental, and personal experiences that can influence how an individual responds, adapts to, and copes with these significant changes (Nelson, 2003). Although there are so many beautiful aspects to growing your family, the added demands, hormonal changes, sleep disturbances, breastfeeding (if this is something you decide), physical changes your body may be going through, and relational changes within your family may all be difficult and require you to have sufficient support, especially given how each of these both individually and combined may increase the risk for POTS flare-ups. It is ok to ask for help, as we all need help sometimes, and your health and well-being are extremely important.

As a society we often focus on the new, beautiful babies (which is important), but often don’t do enough to support new parents, even without POTS, who may be navigating these changes and experiencing postpartum depression. Adding POTS into the mix may understandably require you to have more resources and support available, so we do recommend talking to your team about creating a plan to ensure you have as many resources available to you as possible, just in case. When specifically looking at individuals with POTS, a small study found that around 50% of individuals felt their POTS symptoms were either better than before pregnancy or the same, and at one year post-delivery, the same was true (Blitshteyn et al., 2012). This demonstrates that similar to other answers, where how individuals in our community do during pregnancy varies, the same is true within the postpartum period. It seems to be difficult to predict who will improve, remain the same, or have worsening symptoms. This is an important discussion to have with your loved ones and your medical team so that you have the opportunity to review all potential options and can plan ahead with them.

Will I have more difficulty breastfeeding with POTS?

This is not a guarantee, but it is a possibility and something that is important to be both aware of and mindful of. Given that the total water intake (TWI) recommendations increase for individuals both during pregnancy and when breastfeeding, appropriate hydration is important (Bardosono et al., 2017). Given the increased risk for potential flare-ups during the postpartum period, especially given the known link between inadequate sleep, stress, hormone fluctuations, and POTS flare-ups separate from pregnancy and postpartum considerations, it may be more challenging for breastfeeding mothers with POTS to maintain their hydration status (Morgan et al., 2022).

We recommend tailoring your breastfeeding journey to meet both your physical and mental health needs, as do other researchers, which may require the consideration of alternatives to breastfeeding if you are really struggling (Morgan et al., 2022). It may be helpful to meet with a lactation specialist to express concerns that you have ahead of time, though we can’t encourage you enough to do what is best for your physical and emotional well-being. If supplementing with formula, relying on formula, or pumping is best for you and your baby’s caloric needs, we encourage you to individualize your approach with the support of your care team. It can be very emotionally challenging to navigate breastfeeding difficulties, and is important to remember that a fed baby is ultimately what is best, regardless of what that looks like for you and your family. The baby may not latch well, milk supply may be an issue, or you may find that breast feeding negatively affects your physical or mental health. These are all very valid reasons to reassess your feeding plan. A fed baby with a healthy mother is the best thing. The hope is that you can feed your baby in the way you are most comfortable with, and without added difficulties, alongside the support and compassion from those around you, regardless of what you decide is best.

With the recent birthing process and now the excess fluid loss through breastfeeding you may find it difficult to keep up with your hydration and electrolytes the way you need to in order to successfully breastfeed and keep your POTS well managed. This is NOT a personal failure. Each body is different. Breastfeeding requires extra hydration and calories at a time when you are getting less sleep and have a whole new human being to care for. All of this can prove very taxing physically and mentally. Mother’s physical and mental health should remain a priority (Morgan, et al., 2022).

Are my POTS medications safe for breastfeeding?

Studies supporting the use of POTS medications during breastfeeding are much more limited, but we will update this section as more becomes evidence becomes available. First, there are no breastfeeding studies on fludrocortisone specifically, but the American Academy of Pediatrics does classify this class of medications (glucocorticoids) as being compatible with breastfeeding at this time (“Transfer of drugs…,” 2001). Second, when considering another first-line medication, midodrine, unfortunately there is no significant breastfeeding data at this time. Lastly, one beta-blocker that is often used, propranolol, has been classified by the American Academy of Pediatrics as being compatible with breastfeeding (“Transfer of drugs…,” 2001). We understand how challenging it can be to navigate the uncertainty when hoping to breastfeed and requiring some of these medications to manage your POTS symptoms. We recommend speaking with your team AND your baby’s pediatrician to make the most informed decision, considering the evidence that is currently available and what is best for both you and your baby.

Does POTS increase my risk for postpartum depression and mental health difficulties?

Although we can’t definitively say yes, an analysis of what factors contribute towards postpartum depression (PPD) and other mental health difficulties for new mothers, does suggest individuals in our community may be at higher risk. Overall, approximately 1 in 7 women develop PPD, which is already quite significant and striking (Mughal et al., 2022). The postpartum period alone, separate from POTS or other chronic illnesses, is known to be quite difficult for new parents, especially if they don’t have enough familial support. Researchers have continued to look at risk factors that contribute toward the development of PPD and other mental health challenges, and have found that women with sleep disturbances during pregnancy, women with more severe nausea and vomiting during pregnancy, and women with chronic physical conditions, are all at an increased risk (Maghami et al., 2021; Muchanga et al., 2020; Brown et al., 2019). We are understandably concerned by these findings given the prevalence of sleep disturbances in our community, increased risk for hyperemesis gravidarum for individuals with POTS, and known elevated risk for women with chronic conditions.

Given the added difficulties that new mothers in our community may navigate, we highly recommend frequent mental health screenings and the incorporation of appropriate and proactive mental health support. We would recommend this for all new mothers both during pregnancy and postpartum, but strongly encourage this added support for new moms with POTS and other co-occurring conditions. It is imperative for providers to be aware of these risks and ensure everyone has access to the added mental health support they may need.

Is it baby blues or something more?

Postpartum depression (PPD), postpartum anxiety (PPA) and other postpartum mental health issues are not discussed as nearly as much as they should be. Your OB/GYN will likely screen you for PPD at your postpartum follow-up but if you are struggling with feelings of sadness, hopelessness, worthlessness, worry and/or anxiety for more than two weeks please reach out to your OB/GYN sooner for follow-up, or reach out to your primary care provider or mental health provider if you already have one. It is vital if you feel that you are struggling with sadness, anxiety, depression or any other emotions you reach out for help. Your OB/GYN’s office may have recommendations for local support options. Medications are also an option and can be discussed with your care team.
Resources can be found here:
Resource One
Resource Two
Resource Three

Contributions made by: Mallory Stanislawczyk, CRNP, Pediatric Advisor

Sources:

Bardosono, S., Morin, C., Guelinckx, I., & Pohan, R. (2017). Pregnant and breastfeeding women: Drinking for two? Annals of Nutrition and Metabolism, 70(Suppl. 1), 13–17. https://doi.org/10.1159/000462998

Blitshteyn, S., Poya, H., & Bett, G. C. (2012). Pregnancy in postural tachycardia syndrome: Clinical course and maternal and fetal outcomes. The Journal of Maternal-Fetal & Neonatal Medicine, 25(9), 1631–1634. https://doi.org/10.3109/14767058.2011.648671

Brown, H. K., Wilton, A. S., Ray, J. G., Dennis, C.-L., Guttmann, A., & Vigod, S. N. (2019). Chronic physical conditions and risk for perinatal mental illness: A population-based retrospective cohort study. PLOS Medicine, 16(8). https://doi.org/10.1371/journal.pmed.1002864

Maghami, M., Shariatpanahi, S. P., Habibi, D., Heidari‐Beni, M., Badihian, N., Hosseini, M., & Kelishadi, R. (2021). Sleep disorders during pregnancy and postpartum depression: A systematic review and meta‐analysis. International Journal of Developmental Neuroscience, 81(6), 469–478. https://doi.org/10.1002/jdn.10118

Morgan, K., Smith, A., & Blitshteyn, S. (2022). Pots and pregnancy: A review of literature and recommendations for evaluation and treatment. International Journal of Women’s Health, Volume 14, 1831–1847. https://doi.org/10.2147/ijwh.s366667

Muchanga, S. M., Eitoku, M., Mbelambela, E. P., Ninomiya, H., Iiyama, T., Komori, K., Yasumitsu-Lovell, K., Mitsuda, N., Tozin, R. R., Maeda, N., Fujieda, M., & Suganuma, N. (2020). Association between nausea and vomiting of pregnancy and postpartum depression: The Japan Environment and Children’s study. Journal of Psychosomatic Obstetrics & Gynecology, 43(1), 2–10. https://doi.org/10.1080/0167482x.2020.1734792

Mughal, S., Azhar, Y., & Siddiqui, W. (2022). Postpartum Depression. National Library of Medicine.

Nelson, A. M. (2003). Transition to motherhood. Journal of Obstetric, Gynecologic & Neonatal Nursing, 32(4), 465–477. https://doi.org/10.1177/0884217503255199

The transfer of drugs and other chemicals into human milk. (2001). Pediatrics, 108(3), 776–789. https://doi.org/10.1542/peds.108.3.776

Postpartum Period With POTS

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Awareness for POTSies was founded in 2021. This website was developed with love and a great deal of time and commitment to our community. When sharing any content we developed, we ask that you cite our organization and resources appropriately.