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Advanced Neurology POTS and pregnancy: A case series

Table 3. Summary of obstetric data on patients with POTS in pregnancy
Patient Mode of delivery Gestational Birthweight (g) Presence of Labor‑related Neonatal Long‑term infant
age (weeks) MFM specialist complications complications complications
(Y/N)
1 Cesarean section 37 2438 Y None Pulmonary None
hypertension,
NICU care
required
2 Spontaneous vaginal delivery 39 3583 Y None None None
3 Spontaneous vaginal delivery, 39 3033 Y None None None
forceps-assisted
Spontaneous vaginal delivery 38 3316 Y None None None
4 Spontaneous vaginal delivery, 38 3232 N Temporary Perinatal stroke None
vacuum-assisted hypothermia
Abbreviations: MFM: Maternal-fetal medicine; N: No; NICU: Neonatal intensive care unit; Y: Yes; POTS: Postural orthostatic tachycardia syndrome.

All of the patients reaching the postpartum stage in growing body of evidence regarding medication changes,
our cohort had successful labor outcomes. One patient autonomic dysfunction management, and pregnancy
was considered pre-eclamptic by neurology at the end outcomes of women with POTS.
of gestation, and half of the patients required a labor
induction. BP was heavily monitored during delivery for all 4. Conclusion
patients, which is a recommendation underscored by prior Patients with POTS who wish to undergo pregnancy can
studies. Of these four vaginal deliveries, one was assisted do so safely with reasonable pre-pregnancy management
9,13
by forceps and one by vacuum. Vaginal delivery with pain of their autonomic symptoms. It is advised that these
control is a safe option for most women with POTS. 1,13-16 patients have sufficient support and monitoring. This
In our series, one patient had a scheduled cesarean section should include regular BP and HR monitoring. It is
a week earlier than expected due to poor fetal circulation. highly recommended that patients be followed by
Three patients received epidural anesthesia, which has MFM physicians with experience managing patients
been established to avoid HR and BP fluctuations in with POTS, as well as an autonomic specialist who can
physiological response to labor pain. All infants had follow-up with patients at least every 1 – 3 months to
9
normal-range birth weights. All postpartum patients in adjust medications for symptomatic and BP control.
our study reported POTS symptoms after delivery at the Reducing time to delivery, as well as special attention
pre-pregnancy level. given to BP and HR monitoring, are essential for positive
Three out of the four women did not require fertility outcomes. In addition, autonomic specialists should
treatments for a successful pregnancy outcome. One follow up with patients after delivery to re-establish post-
of the patients in our case series experienced an ectopic delivery medications and monitor for longer-term effects
pregnancy and subsequently underwent successful IVF of pregnancy with POTS as indicated.
treatment (one cycle) for her second pregnancy. While two Acknowledgments
patients delivered infants with adverse neonatal outcomes,
all patients reported successful long-term infant outcomes. None.
Obstetric data for POTS patients in pregnancy, labor, and Funding
delivery are summarized in Table 3.
There are several limitations to our study. First, this None.
case review was conducted as a single-center retrospective Conflict of interest
cohort with a small sample size. Thus, this restricts our
statistical power and precision. Furthermore, our study The authors declare that they have no competing interests.
lacks an age-matched control group of women who are not
pregnant. Finally, our data include patient interviews and Author contributions
questionnaires, which include subjective responses possibly Conceptualization: Anna D. Hohler, Eleni Okeanis Vaou
influenced by personal assumptions and preferences. Data Curation: Alyssa Khoo, Ambreen Zaidi
Despite these limitations, our study adds to a small but Formal analysis: Anna D. Hohler, Alyssa Khoo

Volume 3 Issue 2 (2024) 5 doi: 10.36922/an.3164