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Bourne KM, Nerenberg KA, Stiles LE, Shibao CA, Okamoto LE, Garland EM, Gamboa A, Peltier A, Diedrich A, Biaggioni I, Sheldon RS, Gibson PS, Kealey AJ, Raj SR. Symptoms of postural orthostatic tachycardia syndrome in pregnancy: a cross-sectional, community-based survey. BJOG 2023; 130:1120-1127. [PMID: 36908200 PMCID: PMC10363219 DOI: 10.1111/1471-0528.17437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/09/2022] [Accepted: 12/06/2022] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To evaluate the relationship between postural orthostatic tachycardia syndrome (POTS) and pregnancy. DESIGN Cross-sectional survey. SETTING International. SAMPLE A total of 8941 female patients with a diagnosis of POTS. METHODS Data from the survey were analysed using descriptive measures and stratified for comparisons. MAIN OUTCOME MEASURES Symptom course of POTS during pregnancy. Secondary outcomes included pregnancy loss, POTS onset during pregnancy and the impacts of a comorbid diagnosis of Ehlers-Danlos syndrome or an autoimmune disorder on symptoms during pregnancy. RESULTS Overall, 40.8% (n = 3652) of participants reported one or more pregnancies. Most participants experienced worsening of symptoms in the first (62.6%) and third (58.9%) trimesters and 3 months after pregnancy (58.7%), and 81.1% experienced worsening symptoms at any point in their pregnancy. Most participants with worsening symptoms in the first trimester also experienced worsening symptoms in the second (61.6%) and third (68.1%) trimesters, but if they improved in the first trimester then this improvement persisted in the second and third trimesters. Of participants who reported that POTS was triggered by a specific event (41.3%), 8.1% reported pregnancy as the trigger for the onset. CONCLUSIONS Postural orthostatic tachycardia syndrome symptoms in the first trimester of pregnancy may help predict symptom course throughout the duration of pregnancy. Some individuals may experience an initial onset of POTS during pregnancy. This novel information may guide clinicians in counselling patients with POTS who are planning pregnancy.
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Affiliation(s)
- Kate M Bourne
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kara A Nerenberg
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lauren E Stiles
- Stony Brook University School of Medicine, Stony Brook, New York, USA
- Dysautonomia International, East Moriches, New York, USA
| | - Cyndya A Shibao
- Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Luis E Okamoto
- Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emily M Garland
- Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alfredo Gamboa
- Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amanda Peltier
- Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - André Diedrich
- Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Italo Biaggioni
- Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert S Sheldon
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Paul S Gibson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Angela J Kealey
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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2
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Pollack B, von Saltza E, McCorkell L, Santos L, Hultman A, Cohen AK, Soares L. Female reproductive health impacts of Long COVID and associated illnesses including ME/CFS, POTS, and connective tissue disorders: a literature review. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1122673. [PMID: 37234076 PMCID: PMC10208411 DOI: 10.3389/fresc.2023.1122673] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/03/2023] [Indexed: 05/27/2023]
Abstract
Long COVID disproportionately affects premenopausal women, but relatively few studies have examined Long COVID's impact on female reproductive health. We conduct a review of the literature documenting the female reproductive health impacts of Long COVID which may include disruptions to the menstrual cycle, gonadal function, ovarian sufficiency, menopause, and fertility, as well as symptom exacerbation around menstruation. Given limited research, we also review the reproductive health impacts of overlapping and associated illnesses including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), postural orthostatic tachycardia syndrome (POTS), connective tissue disorders like Ehlers-Danlos syndrome (EDS), and endometriosis, as these illnesses may help to elucidate reproductive health conditions in Long COVID. These associated illnesses, whose patients are 70%-80% women, have increased rates of dysmenorrhea, amenorrhea, oligomenorrhea, dyspareunia, endometriosis, infertility, vulvodynia, intermenstrual bleeding, ovarian cysts, uterine fibroids and bleeding, pelvic congestion syndrome, gynecological surgeries, and adverse pregnancy complications such as preeclampsia, maternal mortality, and premature birth. Additionally, in Long COVID and associated illnesses, symptoms can be impacted by the menstrual cycle, pregnancy, and menopause. We propose priorities for future research and reproductive healthcare in Long COVID based on a review of the literature. These include screening Long COVID patients for comorbid and associated conditions; studying the impacts of the menstrual cycle, pregnancy, and menopause on symptoms and illness progression; uncovering the role of sex differences and sex hormones in Long COVID and associated illnesses; and addressing historical research and healthcare inequities that have contributed to detrimental knowledge gaps for this patient population.
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Affiliation(s)
- Beth Pollack
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | | | - Lisa McCorkell
- Patient-Led Research Collaborative, Washington, DC, United States
| | - Lucia Santos
- Patient-Led Research Collaborative, Washington, DC, United States
| | - Ashley Hultman
- Patient-Led Research Collaborative, Washington, DC, United States
| | - Alison K. Cohen
- Patient-Led Research Collaborative, Washington, DC, United States
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Letícia Soares
- Patient-Led Research Collaborative, Washington, DC, United States
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3
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Morgan K, Smith A, Blitshteyn S. POTS and Pregnancy: A Review of Literature and Recommendations for Evaluation and Treatment. Int J Womens Health 2022; 14:1831-1847. [PMID: 36590760 PMCID: PMC9795856 DOI: 10.2147/ijwh.s366667] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/06/2022] [Indexed: 12/25/2022] Open
Abstract
Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder of the autonomic nervous system most commonly affecting women of reproductive age. Studies on POTS and pregnancy are limited, and there is a lack of clinical guidelines regarding assessment and management of pregnant women with POTS. The purpose of this review is to summarize data from the available studies on the topic of pregnancy in POTS and common comorbid conditions and to provide the clinical recommendations regarding evaluation and treatment of POTS in pregnant women, based on the available studies and clinical experience. We conclude that pregnancy appears to be safe for women with POTS and is best managed by a multi-disciplinary team with knowledge of POTS and its various comorbidities. Importantly, large, prospective studies are needed to better delineate the course and outcomes of pregnancy, as well as possible pregnancy-related complications in women with POTS. Clinicians should be aware of the clinical presentation, diagnostic criteria, and treatment options in pregnant women with POTS to optimize outcomes and improve medical care during pregnancy and post-partum period.
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Affiliation(s)
- Kate Morgan
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Angela Smith
- HNE Health Libraries, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Svetlana Blitshteyn
- Department of Neurology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA,Dysautonomia Clinic, Williamsville, NY, USA,Correspondence: Svetlana Blitshteyn, 300 International Drive, Suite 100, Williamsville, NY, 14221, USA, Tel +1-716-531-4598, Fax +1-716-478-6917, Email
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4
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Postural tachycardia syndrome (POTS) and antiphospholipid syndrome (APS): What do we know so far? Rev Neurol (Paris) 2021; 178:306-314. [PMID: 34895744 DOI: 10.1016/j.neurol.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/21/2022]
Abstract
As part of the non-criteria clinical manifestations, postural orthostatic tachycardia syndrome (POTS), a multisystem autonomic dysfunction, can co-exist with antiphospholipid syndrome (APS). Several pieces of evidence hint on the autoimmune basis of POTS, and its possible association with several autoimmune diseases, including APS. Indeed, the evidence exists in the etiologies, symptomatology, and treatment options. Although infections, viral ones in particular, stress, and pregnancy are etiologies to both POTS and APS, the exact pathophysiological connection is still to be studied taking into consideration the activity of cytokines in both diseases. Nevertheless, certain immunomodulatory treatments used for the catastrophic or obstetrical forms of APS, such as intravenous immunoglobulins (IVIG) and steroids, have been also used for the treatment of POTS resistant to classical treatments. Therefore, our review aims to highlight the association between POTS and APS, shedding light on the common etiologies explaining the pathophysiology of the two disorders, the diagnostic approach to POTS as a possible clinical criterion of APS, and the treatment of APS in the context of treating POTS.
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5
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Park K, Bairey Merz CN, Bello NA, Davis M, Duvernoy C, Elgendy IY, Ferdinand KC, Hameed A, Itchhaporia D, Minissian MB, Reynolds H, Mehta P, Russo AM, Shah RU, Volgman AS, Wei J, Wenger NK, Pepine CJ, Lindley KJ. Management of Women With Acquired Cardiovascular Disease From Pre-Conception Through Pregnancy and Postpartum: JACC Focus Seminar 3/5. J Am Coll Cardiol 2021; 77:1799-1812. [PMID: 33832606 PMCID: PMC8061780 DOI: 10.1016/j.jacc.2021.01.057] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 01/08/2023]
Abstract
Acquired cardiovascular conditions are a leading cause of maternal morbidity and mortality. A growing number of pregnant women have acquired and heritable cardiovascular conditions and cardiovascular risk factors. As the average age of childbearing women increases, the prevalence of acute coronary syndromes, cardiomyopathy, and other cardiovascular complications in pregnancy are also expected to increase. This document, the third of a 5-part series, aims to provide practical guidance on the management of such conditions encompassing pre-conception through acute management and considerations for delivery.
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Affiliation(s)
- Ki Park
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Natalie A Bello
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Melinda Davis
- Division of Cardiology, VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor, Michigan, USA
| | - Claire Duvernoy
- Division of Cardiology, VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor, Michigan, USA
| | - Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Keith C Ferdinand
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Afshan Hameed
- Department of Obstetrics, University of California Irvine, Irvine, California, USA
| | - Dipti Itchhaporia
- Jeffrey M. Carlton Heart & Vascular Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, California, USA
| | - Margo B Minissian
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Harmony Reynolds
- Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H Charney Division of Cardiology Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Puja Mehta
- Emory University School of Medicine, Emory Heart and Vascular Center, Emory Women's Heart Center, Atlanta, Georgia, USA
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Rashmee U Shah
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, University of Utah, Salt Lake City, Utah, USA
| | | | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Nanette K Wenger
- Emory University School of Medicine, Emory Heart and Vascular Center, Emory Women's Heart Center, Atlanta, Georgia, USA
| | - Carl J Pepine
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kathryn J Lindley
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Harding F, Hyndman N, Burns R. Anaesthetic management of postural orthostatic tachycardia syndrome presenting during pregnancy. Int J Obstet Anesth 2019; 39:132-134. [PMID: 30837098 DOI: 10.1016/j.ijoa.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/19/2018] [Accepted: 02/02/2019] [Indexed: 11/29/2022]
Affiliation(s)
- F Harding
- Anaesthetic Department, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - N Hyndman
- Anaesthetic Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - R Burns
- Anaesthetic Department, Royal Infirmary of Edinburgh, Edinburgh, UK
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7
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Morgan K, Chojenta C, Tavener M, Smith A, Loxton D. Postural Orthostatic Tachycardia Syndrome during pregnancy: A systematic review of the literature. Auton Neurosci 2018; 215:106-118. [DOI: 10.1016/j.autneu.2018.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/27/2018] [Accepted: 05/07/2018] [Indexed: 01/25/2023]
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8
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Overview of the management of postural tachycardia syndrome in pregnant patients. Auton Neurosci 2018; 215:102-105. [DOI: 10.1016/j.autneu.2018.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/14/2018] [Accepted: 02/14/2018] [Indexed: 11/23/2022]
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9
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Pezaro S, Pearce G, Reinhold E. Hypermobile Ehlers-Danlos Syndrome during pregnancy, birth and beyond. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/bjom.2018.26.4.217] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sally Pezaro
- Midwife, researcher and lecturer, Faculty of Health & Life Sciences, Coventry University
| | - Gemma Pearce
- Senior research assistant, Centre for Advances in Behavioural Science, Coventry University
| | - Emma Reinhold
- Portfolio GP; Clinical Champion for the Ehlers Danlos Syndromes, Royal College of GPs; Primary Care Advisor, EDS UK
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10
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Abstract
Purpose Postural orthostatic tachycardia syndrome (POTS) is a form of orthostatic intolerance characterized by an increased heart rate upon transition from supine to standing, and head-up tilt without orthostatic hypotension. Its etiology is multifactorial, and no clear cause has been identified. Common symptoms include light-headedness, blurred vision, weakness, cognitive difficulties, and fatigue and are often accompanied by palpitations, shortness of breath, syncope, or gastrointestinal symptoms. Management includes volume expansion, physical counter maneuvers, and pharmacological agents such as fludrocortisone, midodrine, propranolol, and pyridostigmine. The course of POTS in pregnancy is variable and POTS has not been directly implicated in any adverse outcomes for the mother or fetus. Methods Two cases of POTS in pregnancy are presented, along with a review of the literature for reports of POTS in pregnancy. Results Along with our 2 cases, 10 other case reports were identified and included. Conclusion The course of POTS in pregnancy is variable, and not directly linked to increase perinatal morbidity or mortality. Women can safely undergo regional anesthesia, and vaginal delivery with close monitoring of hemodynamic changes.
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Affiliation(s)
- Brianna Lide
- Texas A and M University College of Medicine, Temple, Texas
| | - Sina Haeri
- St. David's North Austin Medical Center, Austin, Texas ; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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