Pregnancy in postural tachycardia syndrome: clinical course and maternal and fetal outcomes

Abstract

Objective: Postural tachycardia syndrome (POTS), a disorder of the autonomic nervous system, predominantly occurs in women of child-bearing age. We set out to determine the clinical course and maternal and fetal outcomes in pregnant women with pre-existing POTS.

Methods: Participants were asked to complete a detailed questionnaire assessing the clinical course of POTS before, during and after pregnancy, as well as complications of pregnancy, labor and delivery and fetal outcomes.

Results: Among 10 women with pre-existing POTS (pregnancy age 28 ± 7 years, range 16-39), with a total of 17 live births, two were complicated by pre-eclampsia, 14 were normal vaginal deliveries and three were C-sections. The rate of severe vomiting or hyperemesis gravidarum in the first trimester was 59%. There were no stillbirths or congenital abnormalities. The average birth weight was 3076 ± 733 grams, with two infants born premature. During pregnancy, POTS symptoms were either improved or stable in six of 10 women, and four of these six women utilized medications for POTS. Six months after delivery, POTS symptoms were improved in three, stable in two and worsened in five women compared to before pregnancy.

Conclusions: POTS may have a variable clinical course in pregnancy, with 60% of women reporting either improved or stable symptoms during pregnancy, and 50% of women reporting either improved or stable symptoms 6 months after delivery. There may be a higher rate of severe vomiting in the first trimester in women with POTS than in general population.