Postural Orthostatic Tachycardia Syndrome (POTS)

*Important: Please consult with your healthcare provider if you have having symptoms of POTS during pregnancy.

Understanding POTS in Pregnancy:
What It Is, How It Feels, and Ways to Manage It

Pregnancy brings many changes to the body, but for some women, it can also lead to a condition called POTS, or Postural Orthostatic Tachycardia Syndrome. If you’ve been feeling unusually dizzy or lightheaded during pregnancy, it’s worth considering whether POTS might be the cause.

What is POTS?

POTS is a form of dysautonomia, which refers to a problem with the autonomic nervous system—this part of your nervous system controls things like heart rate, blood pressure, and digestion. In people with POTS, the body has trouble regulating blood flow and blood pressure when moving from sitting or lying down to standing up. The heart beats faster than usual to compensate for low blood pressure, which can result in uncomfortable symptoms.

POTS is especially relevant in pregnancy because the growing baby puts extra strain on the cardiovascular system, making it harder for the body to keep up. Changes in blood volume and hormone levels can also contribute to this condition.

What Does POTS Feel Like?

The most common symptom of POTS is dizziness or feeling lightheaded along with a racing heart when standing up. Some pregnant women with POTS may also experience:

• A racing heartbeat (tachycardia)

• Fainting or near-fainting spells

• Extreme fatigue, even after rest

• Shortness of breath

• Difficulty concentrating (brain fog)

• Nausea or gastrointestinal upset

Because these symptoms can overlap with other conditions, it’s easy to dismiss them as part of normal pregnancy discomfort. However, if these sensations persist and worsen when standing, it’s worth discussing with your healthcare provider.

How to Know if You Have POTS

If you suspect POTS, your healthcare provider may perform a simple test called the "tilt table test" or ask you to monitor your symptoms at home. Typically, POTS is diagnosed if your heart rate increases by 30 beats per minute or more within 10 minutes of standing up, without a significant drop in blood pressure. It’s important to share all your symptoms with your healthcare team so they can guide you on the right path to diagnosis and management.

Managing POTS in Pregnancy

The good news is that there are ways to manage POTS during pregnancy to help reduce symptoms. Here are some key recommendations:

1. Stay Hydrated

Dehydration can worsen POTS symptoms, especially in pregnancy. Drinking plenty of fluids helps maintain your blood volume and supports better circulation. Aim for at least 1/2 your body weight in water a day and add electrolytes to help maintain balance. You may want to add electrolytes to every glass. If you aren’t feeling a lot better when consistently drinking that amount, you can increase your hydration even more. Some people sip on water nearly continuously.

2. IV Therapy

For women who have trouble maintaining adequate hydration through oral fluids, IV therapy may be a useful treatment. IV fluids can boost blood volume more quickly and efficiently than drinking fluids, providing almost immediate relief from dizziness and fatigue. Speak with your healthcare provider about whether this option might be right for you.If you think you may have POTS, think about getting a therapeutic IV at an IV bar. If you notice a big difference and feel a lot better, you can add IV therapy to your weekly routine.

3. Increase Salt Intake

Salt helps your body retain fluid, which can improve blood volume and reduce dizziness. Adding more salt to your meals or incorporating salty snacks like pretzels or salted nuts can make a difference. Some pregnant women may also benefit from salt tablets. We’ll talk about whether you need salt tablets during your pregnancy.

4. B Vitamins

B vitamins, play an essential role in supporting energy levels and nerve health. Many pregnant women experience fatigue, and for those with POTS, the fatigue can be extreme. A prenatal vitamin with adequate B vitamins or an additional B-complex supplement may help.

Augustine Colebrook at Midwifery Wisdom recommends 100mg of B1 daily for 6 Months to treat POTS symptoms. B1 helps specifically with the sodium recycling issues.

B1 is thiamine. Thioamin deficiency symptoms include loss of appetite, weakness, pain in the limbs, shortness of breath and swollen feet or legs, muscle weakness, problems with coordination, or loss of muscle, fast heart rate, peripheral neuropathy, limb, loss of appetite, sensation of pins and needles in extremities AND FATIGUE! Those are also POTS symptoms.

Foods with thiamine include nutritional yeast, sea vegetables, asparagus and peas, seeds, beans, and fish. But if you’re suffering from deficiency, it might be best to take it as a supplement for some time to verify the amount you’re getting daily is substantial enough to repair.

Try constantly supplementing with B1 for at least 3 months. We can reassess your care plan if the B1, salt and hydration are improving your symptoms significantly.

5. Compression Stockings

Wearing compression stockings can help support blood circulation and keep blood from pooling in the lower body. That will help you stay more comfortable, and can also reduce the risk of dizziness and fainting. This is especially helpful if you spend a lot of time standing.

Conclusion

POTS during pregnancy can feel overwhelming, but with the right strategies, it’s possible to manage the symptoms and continue with a healthy pregnancy. Prioritizing hydration, boosting salt and B vitamins, and considering compression stockings or IV therapy are all valuable tools in helping your body cope with this condition.

Always consult with your healthcare provider before starting any new treatments, as they can guide you based on your individual needs and pregnancy health.