Effect of Pregnancy on Postural Tachycardia Syndrome

Abstract

P ostural tachycardia syndrome (POTS) is defined as the development of orthostatic symptoms associated with an increase in heart rate (HR) greater than 30 beats/min. More severe cases are associated with a standing HR increase greater than 120 beats/min. 1 Orthostatic symptoms most often include light-headedness, palpitations, presyncope, and exacerbations with heat or exercise. 2 Overall, the prognosis of POTS has been reported to be favorable in follow-up studies, with 80% of patients reporting improvement and 60% becoming functionally normal. 3 Onset of POTS occurs predominantly between the ages of 15 and 50 years, 4 with a female predominance. 1,2,[5][6][7] The female-to-male ratio has been reported to be as high as 5:1. 8 Given the female predominance and the occurrence of POTS during the childbearing years, the effects of this disorder on pregnancy is often raised in clinical practice.ObjECTIvES: To compare the clinical presentation, autonomic dysfunction, and pregnancy outcomes in parous and nulliparous women with postural tachycardia syndrome (POTS) and in women with POTS before and after pregnancy. PATIENTS AND METHODS:This study consists of women who had at least 1 pregnancy during which time they met criteria for POTS between May 1993 and July 2009. All patients underwent standard autonomic testing. POTS was defined as a heart rate (HR) increase of greater than 30 beats/min on head-up tilt (HUT) with symptoms of orthostatic intolerance. Patients' charts were reviewed retrospectively to determine pregnancy outcomes. RESULTS:Clinical characteristics related to POTS did not differ between parous and nulliparous women except for disease duration (parous, 3.7±2.6; nulliparous, 2.1±2.2; P<.001). Autonomic dysfunction did not differ between groups (change in HR on HUT: parous, 42.6±12.0 beats/min; nulliparous, 41.3±10.6 beats/min; P=.39). Of 116 total pregnancies, adverse pregnancy outcomes were reported in 9% and maternal complications in 1%. No complication was related to POTS. There was a trend toward modest improvement in autonomic dysfunction before and after pregnancy (change in HR on HUT: before pregnancy, 38.1±22.7 beats/min; after pregnancy, 21.9±14.9 beats/min; P=.07). CONCLUSION:The long-term impact of pregnancy on POTS does not appear to be clinically important. However, there does appear to be a trend toward improvement in the short-term postpartum period. Adverse pregnancy events were similar to those seen in the general public and do not present a barrier to women with POTS who want to have children.Mayo Clin Proc. 2010;85(7):639-644 CASS = composite autonomic severity score; HR = heart rate; HUT = head-up tilt; OI = orthostatic intolerance; POTS = postural tachycardia syndrome; TST = thermoregulatory sweat test However, until recently published data have been minimal. A recent study in 22 women indicated that, although the effect on symptoms related to POTS during pregnancy varied, the actual pregnancy was not affected. 9 The objectives of this study were as follows: (1) to determine whether ...

Postural orthostatic tachycardia syndrome complicating pregnancy: a case report with review of literature

“…In our patient there was no worsening of symptoms. Similarly, the symptoms remained unchanged in 84% and 88% of parous and nulliparous patients, respectively, in a study by Kimpinski et al 2 However, Glatter et al showed progressive worsening beyond six months gestation in two of his patients with severe POTS which was attributed to physiological peak increase in heart rate which will worsen POTS. In contrast, some studies showed improvement in the later part of pregnancy due to increased fluid retention which occurs during this period.…”

“…Adverse pregnancy events were similar to those seen in the general public and do not present a barrier to women with POTS who want to have children. 2 …”

“…The course of POTS in pregnancy is variable with 80% of patients showing improvement and 60% becoming functionally normal. 2 …”

Postural tachycardia syndrome and pregnancy

“…PoTS does not appear to increase the rate of preterm delivery, perinatal mortality or still‐birth compared with the background rate . Reassuringly, the rate of miscarriage in women with PoTS appears to be no greater than that of the general population . However, women with PoTS have a higher rate of severe vomiting or hyperemesis gravidarum in the first trimester (50–60%) compared with the general population .…”

“…14,15 Reassuringly, the rate of miscarriage in women with PoTS appears to be no greater than that of the general population. 20 However, women with PoTS have a higher rate of severe vomiting or hyperemesis gravidarum in the first trimester (50-60%) compared with the general population. [14][15][16] If this does occur, patients need close observation of haemodynamic status, fluid replacement, treatment with anti-emetics and consideration of thrombotic risk.…”