Grant: Travel Awards - Institute Community Support

Background: Postural tachycardia syndrome (POTS) is a common form of orthostatic intolerance, or difficulty standing up. Individuals with POTS have a fast heart beat and symptoms when standing. Despite the primarily female demographic, there is little research investigating the impact of pregnancy in POTS. This study sought to investigate the impact of pregnancy on POTS symptoms using large cohort data. Methods: The "Diagnosis and Impact of POTS" is a structured patient-community based online survey approved by the Vanderbilt University IRB. Between July 2015 and February 2018, 5811 patients (or their parents) with a physician-diagnosis of POTS completed the survey. This analysis was restricted to females who have been pregnant at least once (n=2151). Results: During the first trimester of pregnancy, 62% of POTS patients reported that their POTS symptoms worsened compared to baseline. During the second trimester, 47% reported their symptoms worsened, but 36% reported improved symptoms. In the third trimester, 58% reported worsened symptoms, with improved symptoms in 27%. After delivery, 61% reported worsened symptoms, while 23% reported improvement compared to baseline. Patients who had worsening POTS symptoms in their first trimester were more likely to have worsening symptoms than better symptoms or no change in the second (38% vs. 24%) and third trimesters (43% vs. 19%). Cesarean sections occurred in 29% of patients. Miscarriages occurred in 29% of total pregnancies, and 45% of POTS patients experienced at least one miscarriage. A pregnancy complication was reported in 65% of patients. Patients with Ehlers-Danlos Syndrome (EDS) were more likely to experience a pregnancy complication (74% vs. 61%) than patients without EDS. Conclusions: Individuals with POTS experience a worsening of baseline symptoms during and after pregnancy. Worsening symptoms in the first trimester may be predictive of POTS symptoms in later stages of pregnancy.