Postural tachycardia syndrome and pregnancy

Abstract

Key content Postural tachycardia syndrome (PoTS) is a potentially debilitating autonomic disturbance that primarily affects females between the ages of 15 and 50 years, and may present for the first time during pregnancy. The typical signs and symptoms are vague and therefore the condition is often under‐ or misdiagnosed as pregnancy may induce similar symptoms. If correctly diagnosed and managed, patients have a good outcome; however, a delay in diagnosis may be disabling. PoTS is unfamiliar to most clinicians and its variable course during pregnancy requires a better understanding of the condition. PoTS management in pregnancy may be challenging and clinicians should be aware of common strategies that are suitable in pregnancy. A multidisciplinary approach is essential for correctly diagnosing and managing the condition and optimising pregnancy outcomes. Learning objectives To understand: The common symptoms and signs of PoTS. How to diagnose and manage PoTS safely in pregnancy. The likely course of disease in pregnant women with PoTS. The effect of pregnancy on PoTS. Multidisciplinary antenatal, intrapartum and postnatal considerations required for patients with PoTS. Ethical issues The impact of delayed diagnosis on individuals. The safety of commonly used pharmaceutical agents. The role of psychological support.

POTS and Pregnancy: A Review of Literature and Recommendations for Evaluation and Treatment

“…Vaginal delivery appears to be safe for the majority of women with POTS and is the preferred mode of delivery. 6 , 8 , 9 , 12 , 14 , 15 , 23 With that in mind, decisions regarding delivery should be based on obstetric and surgical considerations rather than POTS. The risk of complications and adverse events during labor and delivery appear to be the same as the general population, and none were attributed directly to POTS in small studies and case reports.…”

“…Post-partum symptoms of POTS remained variable, with half of women reporting their symptoms to be stable, particularly while the mother was still breastfeeding. 8 , 12 , 13 , 16 This may be due, in part, to physical reconditioning and incidental upper body resistance training that naturally occurs when looking after an infant. 6 , 9 , 13 One study reported that 50% of women felt either the same or better compared to before pregnancy, and 50% felt that their symptoms had worsened.…”

“…Symptoms of POTS appear to be variable throughout the pregnancy with a tendency toward improvement during pregnancy. [8][9][10][11][12] Women who reported severe POTS symptoms at the time of conception were more likely to experience a worsening of symptoms during the pregnancy, 8,9 whereas women who had mild to moderate POTS symptoms or did not require medication at the time of conception tended to experience stability or improvement in symptoms during their pregnancy. 10 Autonomic function tests did not differ between women with POTS who had children and those who did not.…”

“…13 In the first trimester, POTS symptoms were often exacerbated, but in the second trimester, there was an overall improvement in POTS symptoms. 8,[13][14][15] The third trimester was variable with some women reporting a worsening of symptoms while other women maintained the feeling of wellness. 10,12,14,15 The improvement in symptoms, particularly in the second and third trimester, is thought to be due to the increase in blood and plasma volumes during pregnancy, which increases blood pressure and cardiac output.…”

A clinical update on hypermobile Ehlers-Danlos syndrome during pregnancy, birth and beyond

“…Throughout pregnancy, birth and beyond, the symptoms of POTS can be variable (Morgan et al 2018). The majority (up to 60%) of people with POTS report symptomatic improvement during pregnancy (Bhatia, Kavi, Nelson-Piercy 2018). However, those that experience severe POTS prior to pregnancy are more likely to decompensate throughout the course of pregnancy with worsening orthostatic intolerance, and as a result can become quite immobile in the third trimester of pregnancy, occasionally necessitating hospital admission (Bhatia, Kavi, Nelson-Piercy 2018).…”