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

Abstract

Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder of the autonomic nervous system most commonly affecting women of reproductive age. Studies on POTS and pregnancy are limited, and there is a lack of clinical guidelines regarding assessment and management of pregnant women with POTS. The purpose of this review is to summarize data from the available studies on the topic of pregnancy in POTS and common comorbid conditions and to provide the clinical recommendations regarding evaluation and treatment of POTS in pregnant women, based on the available studies and clinical experience. We conclude that pregnancy appears to be safe for women with POTS and is best managed by a multi-disciplinary team with knowledge of POTS and its various comorbidities. Importantly, large, prospective studies are needed to better delineate the course and outcomes of pregnancy, as well as possible pregnancy-related complications in women with POTS. Clinicians should be aware of the clinical presentation, diagnostic criteria, and treatment options in pregnant women with POTS to optimize outcomes and improve medical care during pregnancy and post-partum period.

Sexual Dysfunction in Postural Orthostatic Tachycardia Syndrome (POTS): A Cross-Sectional, Case-Control Study

“…There is a higher incidence of gynecologic disorders found among patients with POTS, suggesting a potential link between estrogen fluctuations and POTS symptoms [3]. Moreover, the literature on POTS and pregnancy reveals that pregnancy can precipitate POTS in at least 9% of patients or exacerbate pre-existing POTS in at least half of pregnant women [1,2]. These observations demonstrate the significant role hormonal changes may play in autonomic dysfunction observed in POTS, which can similarly contribute to sexual dysfunction.…”

“…POTS is defined by symptoms of orthostatic intolerance, such as dizziness, lightheadedness, and palpitations, and is often associated with non-orthostatic manifestations, such as fatigue, headaches, gastrointestinal dysfunction, and cognitive impairment (also known as "brain fog"). POTS predominantly affects women of reproductive age and is commonly triggered by growth spurts, menarche, pregnancy, concussion, surgery, vaccination, and infection, including SARS-CoV-2 (1). In conjunction with clinical history, POTS is diagnosed via a 10 min stand test performed at bedside or a tilt table test.…”

“…Clinical experience and several studies concerning pregnancy and gynecologic complications suggest that sex hormones play an important role in symptoms and disease course in patients with POTS [1][2][3]. Since patients with POTS tend to be young women and men in 2 of 13 the prime of their reproductive life, sexual function represents an important consideration, both from the quality of life and reproductive health standpoints.…”

Management of childbearing with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders: A scoping review and expert co-creation of evidence-based clinical guidelines

“…Moreover, as JHS is indistinguishable from hEDS/HSD and considered likely allelic, this guideline should also apply to those diagnostically labelled as having JHS. We also offer strategies in relation to managing the comorbidities associated with hEDS/HSD, although we recognize that further research is required in these areas, and more detailed expert consensus’ remains warranted [ 73 , 74 , 123 ].…”

Childbearing with Hypermobile Ehlers–Danlos Syndrome and Hypermobility Spectrum Disorders: A Large International Survey of Outcomes and Complications

“…hEDS/HSD has been referred to as a "trifecta" with MCAS and manifestations of autonomic dysfunction such as Postural (orthostatic) Tachycardia Syndrome (PoTS) because of high rates of co-occurrence between these conditions [84]. Given that there is also an increased risk of hyperemesis gravidarum in women with PoTS, potential mechanisms might involve a dysfunction of the autonomic nervous system [85]. Hyperemesis gravidarum is a prominent cause of emergency department visits and hospitalisation in pregnancy [86], and so this finding highlights the importance of diagnosing hEDS/HSD, supporting knowledge among perinatal staff and investigating the possible mechanisms implicated (e.g., Mast Cells), thereby potentially developing novel treatments.…”