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. 2023 Aug;130(9):1120-1127.
doi: 10.1111/1471-0528.17437. Epub 2023 Mar 12.

Symptoms of postural orthostatic tachycardia syndrome in pregnancy: a cross-sectional, community-based survey

Kate M Bourne  1 , Kara A Nerenberg  1   2 , Lauren E Stiles  3   4 , Cyndya A Shibao  5 , Luis E Okamoto  5 , Emily M Garland  5 , Alfredo Gamboa  5 , Amanda Peltier  5 , André Diedrich  5 , Italo Biaggioni  5 , Robert S Sheldon  1 , Paul S Gibson  2   6 , Angela J Kealey  1 , Satish R Raj  1   5
Affiliations

Symptoms of postural orthostatic tachycardia syndrome in pregnancy: a cross-sectional, community-based survey

Kate M Bourne et al. BJOG. 2023 Aug.

Abstract

Objective: To evaluate the relationship between postural orthostatic tachycardia syndrome (POTS) and pregnancy.

Design: Cross-sectional survey.

Setting: International.

Sample: A total of 8941 female patients with a diagnosis of POTS.

Methods: Data from the survey were analysed using descriptive measures and stratified for comparisons.

Main outcome measures: Symptom course of POTS during pregnancy. Secondary outcomes included pregnancy loss, POTS onset during pregnancy and the impacts of a comorbid diagnosis of Ehlers-Danlos syndrome or an autoimmune disorder on symptoms during pregnancy.

Results: Overall, 40.8% (n = 3652) of participants reported one or more pregnancies. Most participants experienced worsening of symptoms in the first (62.6%) and third (58.9%) trimesters and 3 months after pregnancy (58.7%), and 81.1% experienced worsening symptoms at any point in their pregnancy. Most participants with worsening symptoms in the first trimester also experienced worsening symptoms in the second (61.6%) and third (68.1%) trimesters, but if they improved in the first trimester then this improvement persisted in the second and third trimesters. Of participants who reported that POTS was triggered by a specific event (41.3%), 8.1% reported pregnancy as the trigger for the onset.

Conclusions: Postural orthostatic tachycardia syndrome symptoms in the first trimester of pregnancy may help predict symptom course throughout the duration of pregnancy. Some individuals may experience an initial onset of POTS during pregnancy. This novel information may guide clinicians in counselling patients with POTS who are planning pregnancy.

Keywords: Ehlers-Danlos syndrome; autoimmune disorder; first trimester; gestation; postural orthostatic tachycardia syndrome; pregnancy; survey; symptoms.

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Figures

Figure 1.
Figure 1.
Participant Flow Diagram. A total of 8,941 females with a physician-made diagnosis of postural orthostatic tachycardia syndrome (POTS) participated in this analysis.
Figure 2.
Figure 2.
A-B: Postural orthostatic tachycardia syndrome (POTS) symptoms in the second trimester (T2) and third trimester (T3) for participants who had better POTS symptoms in the first trimester (T1), compared to pre-pregnancy. C-D: Symptoms in T2 and T3 for participants who had worse POTS symptoms in T1 compared to pre-pregnancy.
See this image and copyright information in PMC

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