Pregnancy With Pots And Meds

[timk]

First off I'm new to this website. My wife is the one with POTS and I'm doing everything I can to help her out. Here's a little bit of her history. A year after we were married she started passing out monthly. Then weekly. Then it was up to three times a day. I have caught her over 900 times from blackouts. She was bed ridden for a year and a half until we finally found a Dr who diagnosed her. She was put on Midodrine, told to drink LOTS of water and wear stockings. What a difference. She now has a part time job as a medical transcriptionist and is doing better.

We recently found out that she was pregnant with out first child. We asked our Drs about Midodrine and what to do since she was pregnant. We were told to stay on it by one and to take her off it by another. I've done extensive research about the drug and pregnancy and everything comes back that it's a C class drug and nobody knows anything except what it does to mice and rats given 10 to 13 times the dose.

I've read on the past forums from a year ago about women on Midodrine and pregnancy but was wondering if anyone had any recent experiences being on Midodrine while pregnant. Any little info will help.

Thanks

Timk

[Noreen]

Hello TimK-

Welcome to the site. You sound like such a wonderful man and husband. I am sure your support has been instrumental in your wife's ability to get through all this.

So everyone knows category C is when there is no info or only animal studies - from drug.com -

Animal studies have revealed an increase in the rate of embryo resorption, reduced fetal body weight, and reduced fetal survival when administered in doses up to 13 times the recommended human dose. Animal studies have failed to reveal evidence of teratogenicity. There are no controlled data in human pregnancy. Midodrine is only recommended for use during pregnancy when benefit outweighs risk.

From Medscape

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

So it is a risk versus benefit analysis. Many doctors automatically say no to any drugs during pregnancy without doing the research. Falling during syncope presents a huge danger to the fetus and so would, in my opinion, justify the use of it during her pregnancy. Taking the smallest amount while maintaining efficacy seems prudent. What options did the 'No' doctor offer you?

[GApotsie]

This is such a tricky area. As a nurse, I am very skeptical about taking anything Class C with pregnancy; then again, I know syncope while pregnant is not good either. I would ask the doctors for specific rationales for the "yes" and the "no." They normally look at risks vs. benefits. I am 30 and newly diagnosed. The first thing my EP discussed was pregnancy, as we do not have children yet and were hoping to start trying soon. He basically said no Class C drugs. He didn't mention the rationale behind Midodrine, as I am not on it now. He discussed Florinef and Norpace CR in detail with me since I am taking it. He said it is ideal to get the symptoms (syncope particularly) under control and then go drug-free for the first and second trimesters. This is certainly individualized based on the patient. Press both doctors for their rationales. I think doctors are sometimes hesitant to give specific answers because they do not want to be responsible for the outcomes. When I got copies of my medical records, the one physician had made a HUGE note about my medications being discussed and the risks associated with pregnancy. He wrote MORE than he said to cover his buttocks I am sure.

[MomtoGiuliana]

I would try to see a high risk ob/gyn as soon as possible. They tend to be most helpful in weighing risk and benefits of drugs when pregnant. Most cardiologists and other specialists will be extremely conservative about drug use during pregnancy, in my limited experience.

[HopeSprings]

I agree with the advice given -- see a high risk OBGYN with knowledge of POTS and weigh the risks vs. benefits of the medication. I personally don't trust most drugs in pregnancy (or at all for that matter), but if she is gonna pass out without them, I don't know! Maybe if salt loading helps your wife, the extra fluid of pregancy will help and she won't need medication? There are some women with POTS who feel better while pregnant, maybe she will be one of the lucky ones. Another thing I want to mention (I just went through this two years ago) is maybe have her get a consultation with the anesthesiologist if she thinks she may have an epidural. The epidural can cause issues for us. Good luck -- I really hope she has a smooth pregnancy.

[janiedelite]

When we were trying to get pregnant, I went to a high-risk OB-GYN. I second the advice to get a consult from someone with that expertise. You could even call around and see if there's one in your area who would be knowledgeable about treating a pregnant woman who has an underlying disorder that causes BP irregularities and fainting.

[timk]

Thanks for all the advice. We went to our ob/gyn today and he called an ob/gyn medication specialist up in St Louis. We were told to stay on Midodrine but only at half the normal dosage. We are going to a high risk ob/gyn next week so I will have an update of their advice then.

Thanks for listening

Timk

[icesktr189]

I quit all my medications when I found out I was pregnant. This included midodrine, florinet, and metroprolol. I am however not a "passer outter". I have on occasion and come VERY close to syncope, but never really do.

You have to out weight the risks. I decided i would just put up with POTS symptoms, unless they started affecting baby. THe good part of pregnancy is that it expands your blood volume, so she might not need them or as much. I also quit smoking, which really helped with my fatigue and POTS symptoms.

Some anti depressants are safe in pregnancy, and they can really help out POTS symptoms. Maybe should could look into that ?

good luck, i know how stressful it is to deal with POTS, let alone taking care of another life inside our messed up bodies!

[icesktr189]

Oh just wanted to add a had a very succesful epidural beacuse my doctor really listened to me. I LOADED up on Iv fluids and compression stalkings.