Help - Pregnant!

[deucykub]

I am 8 1/2 weeks pregnant - completely unplanned. We are overjoyed but really scared given my medical condition. I honestly didn't think I could get pregnant!

I'm 34 and will be 35 when I deliver, and because I was so focused on POTS, I didn't have any regular OB/GYN visits. Now I am pregnant and don't have an OB that understands POTS!

I need to educate an OB fast on POTS as well as POTS and pregnancy. Unfortunately, I can't read or write for long without severe nausea and dizziness (which has left me on short term disability for the month...). Normally I would research this myself, but I'm in a bit of a bind. Can anyone point me to research or provide pointers/tips on POTS and pregnancy?

Thank you so much!

[Rachel]

Congratulations! I'm happy for you, and hope that everything goes well for you and your baby.

There hasn't been much research on POTS and pregnancy. There have been many members on this forum who have had successful pregnancies, however. Personally, I felt much better during pregnancy. I did very well, and my son was born at 41 weeks completely healthy. The only problem I had was that during labor my uterus didn't not contract as strongly as it should have. I had to be given pitocin for the last 2 hours of labor, which is a very minor intervention all things considered. I also had an epidural toward the end of labor so that I could sleep and get some rest.

You can do a search on the forum for previous discussions on pregnancy. There have been quite a few.

This is a statement about POTS and pregnancy from Dr. Low that can be found here.

The effect of pregnancy on POTS and on patients with OH are two different questions. We have limited information on POTS and pregnancy. These patients being typically female and being fertile can become pregnant. Our patients have managed very well during their pregnancy and the delivery. They typically do very well during their pregnancy, feeling better than when they were not pregnant, especially during the first and second trimesters.

They should not be on any medications during their pregnancy.

The advice I give is as follows. They need to feel sufficiently well that they can manage without any medications. They need to be on a high salt, high fluid regimen. Their pregnancy should go well but should be managed as a high risk pregnancy by their obstetrician. During their delivery, their physicians need to ensure that they are volume expanded and like other high risk deliveries, they should not have to undergo prolonged labor. Finally, I tell them that they should be aware that they may feel worse in the puerperium (after their delivery) when their symptoms may return.

Patients with MSA, PAF and the autonomic neuropathies are more often older patients who have had their families, so that the question of pregnancy usually does not arise. The same advice that I give to POTS about medications and delivery applies. Additionally, they should be aware of two additional facts. First, they have generalized autonomic failure, so that their BP control is poor and the stress of pregnancy is a major stress to the autonomic nervous system. Second, the drugs that are sometimes used during delivery may have unexpected effects. Specifically, they may have denervation supersensitivity to certain drugs, so that an excessive rise in BP can occur with certain drugs. Some hypotensive drugs can cause their BP to plummet. In general, we do not recommend pregnancy for patients with generalized autonomic failure.

Dr Phillip A. Low , M.D.

I hope that all goes well for you.

Rachel

[MomtoGiuliana]

Congratulations and good luck! I was pregnant at 33 with my only daughter. As was already said, there is not a lot of info out there. You will see a large range of experiences on this board with pregnancy. Unfortunately, no magic ball.

You should be treated as high risk and therefore see a high risk ob/gyn. High risk ob/gyn may not know about POTS, but they know more about medications and are better able to evaluate (with your other doctors) the risks and benefits of using meds with pregnancy.

I was undiagnosed and therefore not treated as high risk, despite bad symptoms, during my pregnancy. I think if I had a diagnosis things could have been done to have made my experience more tolerable--e.g., more fluids and salt, etc. I was fine through the 1st and much of the 2nd trimester. But unable to work during the last two months. Again, your experience could be totally different.

I hope everything goes well for you.

Katherine

[deucykub]

Thank you! My first trimester has been awful so far, but my fingers are crossed that the symptoms will subside in the 2nd.

[ajw4790]

Congratulations!!! I don't have any words of wisdom, but I hope that everything goes well for you and your baby!

Hopefully you will start to have less symptoms soon!

[bizbiz]

Hello and congratulations on your pregnancy! I loved being pregnant and feeling the baby move is the amazing thing in the world! I wish you all the best and hope everything goes well for you.

I got POTS literally the day my little boy was born (7 months ago). Although looking back now I believe I had symptoms throughout my whole pregnancy. I had episodes of tachyardia, fatigue and dizziness, but I thought at the time that they were pregnancy related. However apart from these occasional symptoms, my pregnancy was fine.

The only things I can recomend to you are to try to stay as active as possible. I know this is hard with POTS, but if you are able to at least go for a walk every day I think that would help. I have horses, so I was still going out to feed them everyday, but I stopped my daily power walk early on in the pregnancy and slept a lot, so I often wonder if the POTS would have hit me so hard if I had stayed more active. Also, like others have mentioned, find yourself a good high risk OB - I had a VERY long labour, and have since read that this is a no-no for us. I didnt sleep or eat for the 2 days (almost 3) before the labour, so I was extremely fatigued and dehydrated, and I also believe that this contributed to my crash. Try to keep yourself as well hydrated as possible and keep up with your sleep.

And dont be too hard on yourself after the labour - childbirth is exhausting for a non-POTS person, let alone someone with a chronic illness. Try to have a good support group (partner, mother, sister, family etc) for when you get home. Even though I was exhausted after the labour I was so excited and so full of adrenaline that I didnt use the time in hospital to sleep, so that when I got home I was over tired!! Plus I was hit with POTS, so I was exhausted. Looking back now I wish I had people over to look after the baby while I recovered, instead of trying to do everything myself.

[Fallon2120]

Congratulations! That is great! I don't have any adive because I don't have children yet, but I am very curious to hear what others say. My husband and I are going to start trying to get pregnant this Fall, and since not a lot is known about POTS and pregnancy all we have to go on is what others have experienced. Good luck! I am sure things will be just fine. Keep us updated. I would love to know how you are doing!!

[janiedelite]

Congratulations Deucykub!!! My hubby and I had put off getting pregnant until I was seen at Mayo and were certain I didn't have anything more than POTS and neuropathy. They gave us the okay, so I hope to join you soon in the pregnant-POTS club!

Last year, my regular gyno (who's also a great OB) knew we wanted to get pregnant but sent me to a high-risk OB because of my crazy symptoms, just so we could be prepared for when we start trying to get pregnant. The high-risk OB said he's only delivered one other POTS patient and she felt awful during her pregnancy, and he did a C-section to avoid a difficult labor. During this time, I got diagnosed at Mayo and the doc there said it should be fine for me to get pregnant and advised the OB to watch for hypertension. He said that since I'm not on any regular POTS meds and am pretty stable right now, he wants to ask my regular OB/gyn to see if she'll be willing to take me back. I see her for my yearly appt in 2 weeks and I'm going to ask her how comfortable she is with managing me if I get pregnant. However, I know that if I am her patient and go into labor, I might end up with her or with her partner.

So what's better, a high-risk OB who doesn't know much about POTS or regular OB who I really like but also doesn't know much about POTS???

P.S. I'm sure the high-risk OB would be willing to take me back if I started having complications my regular OB couldn't handle.

Congrats again, and like I mentioned the Mayo doc told me to watch for hypertension because our blood volume explands during pregnancy.

Take care, Janie

[lalalisa]

Congratulations !!

I'm excited for you!! When I found out I was pregnant I found a high risk OB who I felt confident with. (I went to one and just didn't feel confident with her so I went to another and love her) She doesn't necessarily have experience with POTS but I would guess that any high risk OB would have experience with various symptoms of POTS such as tachycardia and low blood pressure. (mine does and has been really helpful)

I am 37 weeks pregnant right now and anticipating labor/delivery/recovery/breastfeeding as a POTS patient. There are lots of questions and unknowns concerning the weeks ahead but I'm just trying to take things in stride.

I hope you find a great dr. who helps you feel confident about the days/weeks ahead.

Blessings!

Lisa

[masumeh]

Congrats!

Briefly, my advice is to let your OB/GYN consult with your POTS doctor. They should communicate directly with each other.

My OB consulted with several other specialists during my pregnancy, including a perinatologist, endo, pulmonologist and hemotologist. She was very cooperative. The most important thing about her was her great memory...she remembered every detail of my complex history.

[greensunflower]

I can imagine that POTS symptoms could get better with pregnancy because of the steep increase in blood supply. Vibes your second trimester is better than the first.

[flop]

Congratulations! I wouldn't worry about not having been with a regular OB before now, at 8/9 weeks you have time to find and choose and OB that you feel comfortable with. I would look up some local high-risk OBs and go for an initial consult to see if you get a good feeling that they will be willing to work with you. They will problably never have heard of POTS but if they are willing to read and learn you should do fine.

I remember that doctorguest is trying to get funding to do research on POTS and pregnancy. If you search for doctorguest's threads there is a contact link and I think that all you have to do is answer a simple questionaire about POTS and pregnancy (anyone who has been pregnant with POTS can take part). Hopefully in the future we will have more information about POTS and pregnancy but for now just try to relax and enjoy the experience.

Flop