Preparing For Safe Pregnancy

Applicable Questions and Answers Listed Below:

Can I still have a healthy pregnancy with POTS?

Although a lot does need to be taken into consideration, including medications you may need to take, maternal age, and other co-occurring conditions you may have, individuals with POTS can still have healthy pregnancies. Though there is a lot of variation within our community, and the severity of POTS can certainly vary alongside potential other co-occurring conditions, researchers and providers have continued to state that they believe individuals with POTS who would like to get pregnant can do so safely (Kanjwal et al., 2012; Morgan et al., 2022). Researchers have found that those with mild to moderate forms of POTS “have similar pregnancy outcomes to the general population” (Bhatia et al., 2018). We should note that despite this, it is important to discuss fall precautions with your team related to syncope, and those in our community with EDS and other co-occurring conditions should also be more closely monitored given the risk for more complications (Ruzieh et al., 2017).

Is there a POTS and pregnancy support group?

Yes! There is one that comes to mind specifically on Facebook. Though we can’t speak to the quality of the group and how helpful it may be for you, we can say that there are a few thousand individuals within the group who often ask questions and can offer added support/share their own personal experiences. We will say that this is not a place where you can get helpful medical advice, but rather added peer support. The group is called “P.O.T.S & Pregnancy/Families,” and they have around 4,000 members.

Can individuals with POTS feel better when pregnant?

This varies quite considerably but some do, yes. Our answer to this is based on a few studies by Blitshteyn et al., Kanjwal et al., Morgan et al., and Bhatia et al. (2012; 2009; 2022; 2018). The increase in blood volume and fluid retention experienced during pregnancy can certainly be helpful for some individuals in our community as one potential explanation for those who experience improved symptoms (Bhatia et al., 2018)! This being said, all of the studies also note that some feel about the same, and others in our community can feel worse, so you aren’t alone if pregnancy was a more difficult time/experience for you, or if you didn’t experience any changes (Blitshteyn et al., 2012; Kanjwal et al., 2009; Bhatia et al., 2018; Morgan et al., 2022).

What is it like to be pregnant with POTS?

This is a great question. First, we will say that it can vary considerably and appears to be influenced by the POTS severity before getting pregnant (Bhatia et al., 2018; Powless et al., 2010; Morgan et al., 2022). Individuals experiencing symptom improvement, or the stability of symptoms throughout, were more likely to have mild symptoms prior to pregnancy, moderate symptoms prior to pregnancy, or did not require medication when conceiving (Morgan et al., 2022). Other co-occurring conditions may influence this as well, so it is important for providers to be mindful of this. Around 60% report feeling better during pregnancy, especially when on medication (though we found that this statistic can vary slightly depending on the study), 12–15% have stable symptoms throughout, and about 30–40% report feeling worse (Kanjwal et al., 2009; Glatter et al., 2005; Bhatia et al., 2018; Morgan et al., 2022). There is a higher chance for individuals in our community to experience hyperemesis gravidarum (a more severe form of nausea and vomiting that can occur during pregnancy with about a 59% incidence in our community), so this is important for your providers to be aware of (Blitshteyn et al., 2012). Providers aren’t fully sure why this is the case, but one potential theory or contributing factor to consider is that it is related to co-morbid migraines as there is an association between migraines and hyperemesis gravidarum in pregnancy (Blitshteyn et al., 2012; Heinrichs, 2002).

Can pregnancy cause POTS?

Unfortunately, yes, some find that they may have POTS symptoms that develop during pregnancy and resolve, while others may develop POTS after pregnancy. Although researchers aren’t fully sure why this occurs, immunological stressors are believed to trigger POTS (Fedorowski, 2019). If this is something you have experienced, we want to take time to acknowledge how difficult we understand it may be, both adapting to new changes as a parent, while also adapting to new changes that arise when navigating an illness like POTS. We hope that our other sections throughout the website offer additional support, and please don’t hesitate to reach out to our team if you need added support or have other questions we haven’t answered. If helpful, you can also visit our What Causes POTS section to learn more about various POTS triggers.

Are my POTS medications safe for pregnancy?

Some medications taken by individuals in our community recommended to help manage POTS symptoms can be prescribed during pregnancy, but research is still limited, and we can’t speak to all medications or medications taken for other co-occurring conditions. Most of the first-line medications prescribed (like beta-blockers, fludrocortisone, and midodrine) are considered category C for pregnancy, where risks can’t be ruled out, but the benefits may outweigh potential risks. One example of a medication that is category B for pregnancy is pyridostigmine (Bhatia et al., 2018). Receiving IV Normal Saline infusions is another potential safe option to discuss with your team if your POTS symptoms are severe. The use of IV Normal Saline to increase blood volume, though not studied well in those who are pregnant with POTS, has been proven to help significantly both with improving quality of life and symptom reduction (Ruzieh et al., 2017). It appears that the use of 1 liter over a period of 1–2 hours each week can be helpful but should be titrated as tolerated as individualized care is important (Ruzieh et al., 2017). To learn more about these see our Managing Symptoms pharmacological treatments section.

It is important to note that Ivabradine is not considered a safe medication option as it is considered category D for pregnancy, and the safety of Octreotide is not fully clear (Bhatia et al., 2018). Although there are no controlled data in human pregnancy for Ivabradine, concerning evidence from animal studies leads to a need for those on the medication to be advised to use contraception. Because all of us are different and the way medications can impact us can vary considerably, discussing what medication options you have with your team can be helpful and important. The goal is to try to manage symptoms without medications, if possible, by weaning prior to a pregnancy, but it is always best to weigh the risks and benefits (Ruzieh et al., 2017). The increase in blood volume during pregnancy for about 2 liters can enable a reduction or elimination of helpful medications before the pregnancy, but this does need to be determined by your medical team given how much variability there can be.

When will I know if my POTS symptoms will get worse during pregnancy?

It is unfortunately very hard to say and difficult to predict. We wish we had a clear answer for you but the current research is limited. We will say that researchers have found that about 1/3 of individuals experience worsening symptoms only during the first trimester, 1/3 around 24 weeks continuing through the pregnancy, and 1/3 with these symptoms throughout (Kanjwal et al., 2012; Glatter et al., 2005). Other studies have reinforced symptom exacerbation during the first trimester with improvements for some during the second trimester, and more variability during the third trimester, believed to be related to increased cardiac output associated with increased blood volume later in pregnancy (Morgan et al., 2022).

How can I get symptom relief if my physical symptoms worsen during pregnancy?

If pre-existing symptoms worsen, researchers have found that the worsening symptoms are often specific to increased presyncope, syncope, and/or migraines (Corbett et al., 2006; Glatter et al., 2005, Kanjwal et al., 2012). Some found that increasing the doses of medications individuals were already on proved to be helpful; one cited example included increasing doses of beta-blockers (Powless et al., 2010). As mentioned above, there is also a higher chance for individuals in our community to experience hyperemesis gravidarum (a more severe form of nausea and vomiting which can occur during pregnancy with about a 59% incidence in our community), so this is important for your providers to be aware of as well (Blitshteyn et al., 2012). Some with more severe symptoms may require IV hydration (Bhatia et al., 2018). This may be something individuals in our community can discuss with their medical teams proactively. It is also important to consider the benefits associated with non-pharmacological interventions, with a number of options within our Managing Symptoms section for individuals with POTS, in collaboration with your care team to decide what interventions are best and most appropriate. Some of these specific to pregnancy may include the incorporation of light exercise, increased daily sodium chloride consumption (7 grams or more), the use of waist high compression garments, and a daily fluid intake of at least 2.5L, but recommendations will need to be tailored to meet your individual needs (Morgan et al., 2022).

Do I need to be followed by a high-risk team if I have POTS?

This is a difficult question to answer and will vary as a great deal needs to be taken into consideration. Maternal age, past medical history, current diagnoses, needed medications, fetal health, and how you are tolerating the pregnancy are all factors that can influence the need to be followed by a high-risk obstetrics team. Asking your providers ahead of time may be a good idea, and you can also consider scheduling a pre-conception appointment with a high-risk obstetrics practice to determine what their feelings are specific to your history (if this is something you feel would be helpful). Although this pre-conception appointment doesn’t take into consideration changes during pregnancy and the health of the baby which may be unforeseen and could change your need to be followed by them, it may still be helpful if you have a number of questions. You deserve to have those questions answered.

Do individuals with POTS experience more miscarriages?

We are not sure, unfortunately. Some data did appear to suggest that individuals with POTS may experience more miscarriages on average, as there was an approximate 41% rate of miscarriage; this being said, they felt it was too premature to conclude or make any statements one way or the other based on their small sample size (Blitshteyn et al., 2012). They felt that a larger study needed to be done before drawing any conclusions or assuming that there is a causal relationship between POTS and incidence of miscarriages (Blitshteyn et al., 2012).

Sources:

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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

Bhatia, M., Kavi, L., & Nelson-Piercy, C. (2018). Postural tachycardia syndrome and pregnancy. The Obstetrician & Gynaecologist, 20(2), 119–123. https://doi.org/10.1111/tog.12478

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

Corbett WL, Reiter CM, Schultz JR, Kanter RJ, Habib AS (2006). Anaesthetic management of a parturient with the postural orthostatic tachycardia syndrome: a case report. Br J Anaesth ;97:196–9.

Fedorowski, A. (2019). Postural orthostatic tachycardia syndrome: Clinical presentation, Aetiology and management. Journal of Internal Medicine, 285(4), 352–366. https://doi.org/10.1111/joim.12852

Glatter KA, Tuteja D, Chiamvimonvat N, Hamdan M, Park JK. (2005). Pregnancy in postural orthostatic tachycardia syndrome. Pacing Clin Electrophysiol 2005;28:591–3.

Kanjwal, K., Karabin, B., Kanjwal, Y., & Grubb, B. P. (2009). Outcomes of pregnancy in patients with preexisting postural tachycardia syndrome. Pacing and Clinical Electrophysiology, 32(8), 1000–1003. https://doi.org/10.1111/j.1540-8159.2009.02430.x

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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

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Ruzieh, M., & Grubb, B. P. (2018). Overview of the management of postural tachycardia syndrome in pregnant patients. Autonomic Neuroscience, 215, 102–105. https://doi.org/10.1016/j.autneu.2018.02.002

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Preparing For Safe Pregnancy

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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.