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Advanced Neurology

CASE SERIES
Postural orthostatic tachycardia syndrome

during pregnancy, labor, and post-delivery: A
case series

2
1
Alyssa Khoo * , Yogi Saxena , Ambreen Zaidi 2 , Eleni Okeanis Vaou 1,3 , and
Anna D. Hohler 1,3
1 Department of Neurology, St. Elizabeth’s Medical Center, Brighton, Massachusetts, United States
of America
2 Department of Neurology, Tufts University School of Medicine, Boston, Massachusetts, United
States of America
3 Department of Neurology, Faculty of Neurology Education, Boston University Chobanian and
Avedisian School of Medicine, Boston, Massachusetts, United States of America

Abstract
Postural orthostatic tachycardia syndrome (POTS) is an autonomic condition
characterized by the presence of a >30 bpm increase in heart rate, accompanied by
orthostatic symptoms, including heart palpitations, light-headedness, weakness,
blurred vision, nausea, and headache. Females are commonly affected by POTS
at childbearing age. This case series aims to compare the clinical presentations,
autonomic dysfunction management, and pregnancy outcomes of four women
with POTS. In our autonomic neurology clinic, the goal for our patients is consistent
blood pressure during pregnancy. The patients were all interviewed retrospectively
*Corresponding author: to determine pregnancy outcomes. Our study indicates the need for neurologists
Alyssa Khoo
(ayk9839@nyu.edu) to collaborate with a team of maternal-fetal medicine specialists with advanced
training in high-risk pregnancies to optimize autonomic function throughout the
Citation: Khoo A, Saxena Y,
Zaidi A, Vaou EO, Hohler AD. course of pregnancy. In addition, our results suggest that reducing medications to
Postural orthostatic tachycardia minimize harm can be achieved through regular monitoring at 1 – 3 month intervals
syndrome during pregnancy, labor, during pregnancy, with a 6-week postpartum evaluation.
and post-delivery: A case series.
Adv Neuro. 2024;3(2):3164.
doi: 10.36922/an.3164
Keywords: Postural orthostatic tachycardia syndrome; Autonomic dysfunction;
Received: March 14, 2024 Obstetrics; Hypertension; Tachycardia
Accepted: June 11, 2024
Published Online: June 27, 2024
Copyright: © 2024 Author(s). 1. Background
This is an Open-Access article
distributed under the terms of the Postural orthostatic tachycardia syndrome (POTS) is characterized by the presence
Creative Commons Attribution of a >30 bpm increase in heart rate (HR) when moving from a supine to a standing
License, permitting distribution,
and reproduction in any medium, position. This increase is often accompanied by a constellation of symptoms, including
provided the original work is heart palpitations, light-headedness, weakness, blurred vision, nausea, and headache.
properly cited. Importantly, the increase in HR and accompanying symptoms occur without evidence of
Publisher’s Note: AccScience orthostatic hypotension (a decrease in blood pressure (BP) >20/10 mmHg with postural
Publishing remains neutral with change). POTS is significantly more prominent in female patients of childbearing
regard to jurisdictional claims in 1-5
published maps and institutional age, with most patients presenting between 15 and 25-years-old. Clinical guidelines
affiliations for autonomic specialists regarding the management of patients with POTS during

Volume 3 Issue 2 (2024) 1 doi: 10.36922/an.3164