Table 1.

Overview of Included Literature

Publication Year	Reference	Study Design / Number of Cases	Symptoms Course of POTS in Pregnancy	Medications use During Pregnancy	Antenatal Complications	Labour Analgesia/ Anaesthesia	Mode of Delivery	Neonatal Outcomes	Postnatal POTS Symptoms
2005	Glatter et Al	Case report / 2	Variable - decompensation at 6 months, placed on bedrest at 7 months	Midodrine	Hyperemesis gravidarum, severe dyspnoea, tachycardia, syncope	Epidural without complication	Elective caesarean section at 37 weeks due to maternal clinical decompensation	Live birth, no complications to baby	Improved
			Variable - decompensation at 6 months, bedrest at 30 weeks	-	Hyperemesis gravidarum, syncope, tachycardia, premature labour at 30 weeks	-	Elective caesarean section at 37 weeks due to maternal clinical decompensation	Live birth, no complications to baby	Improved
2006	Corbett et Al	Case report / 1	Worsened	Metoprolol	-	Epidural, proceeding to general analgesia post-delivery for haemodynamic instability	Emergency caesarean section for active phase arrest	Live birth, no complications to baby	Improved
2007	McEvoy et Al	case report / 1	Stable	Fludrocortisone, propranolol	Pregnancy induced hypertension	Epidural	Assisted forceps	Live birth, no complications to baby	-
2009	Kodakkattil & Das	Case report / 1	Unchanged	-	Threatened preterm labour, syncope with seizure	Epidural without complication	Induced vaginal	Live birth, no complications to baby	Stable
2009	Jones & Ng	Case report / 1	Worsened	-	-	Epidural without complication	Elective caesarean section at 38 weeks	Live birth, no complications to baby	-
2009	Kanjwal et Al	Retrospective chart review / 22	Variable - unchanged 13%, improved 55%, worsened 31%	β-blockers, midodrine, selective serotonin reuptake inhibitors, fludrocortisone	Hyperemesis gravidarum, complete heart block	-	Vaginal, caesarean section	Down’s Syndrome, asymptomatic ostium secundum atrial septal defect, ventricular septal defect	Unchanged 69%, worsened 27%, depression
2010	Powless et Al	Retrospective chart review / 7 women, 9 pregnancies	Variable	β-blockers, midodrine, fludrocortisone, pyridostigmine	Gestational hypertension, preterm premature rupture of membranes with premature onset of labour, oligohydramnios, chronic placental abruption, breech presentation, premature rupture of membranes	Epidural	Spontaneous vaginal, induced vaginal, elective caesarean section	Live births	-
2010	Kimpinski et Al	Retrospective chart review / 51 women - 116 pregnancies, parous Vs nulliparous	Variable	-	Miscarriage, placenta previa, placental abruption and malpresentation resulting in peripartum hysterectomy	-	-	Live birth, no complications to baby	Improved
2012	Blitshteyn et Al	Self-reported questionnaires with longitudinal follow up / 10 women - 42 pregnancies, 25 miscarriages, 17 live births	Variable - unchanged 20%, improved 40%, worsened 40%	Fludrocortisone, β-blockers, midodrine	Hyperemesis gravidarum, tachycardia, hypotension, fatigue, presyncope, anaemia, pre-eclampsia	Epidural, general, unknown	Vaginal, emergency caesarean section, forceps delivery	Prematurity (<32 weeks), fetal distress syndrome	Unchanged 20–40%, improved 10–30%, worsened 50%
2012	Pramya et Al	Case report / 1	Stable	Metoprolol	-	Epidural without complication	Spontaneous vaginal	Live birth, no complications to baby	Stable
2015	Lide & Haeri	Case report / 2	1 exacerbation at 15 weeks	Propranolol commenced at 15 weeks	-	epidural without complication	Spontaneous vaginal	Live birth, no complications to baby	Stable
			1 exacerbation at 10 weeks	Propranolol commenced at 10 weeks	Hyperemesis gravidarum	Epidural without complication	Spontaneous vaginal	Live birth, no complications to baby	Stable
2018	Bhatia et Al	Clinical review	Variable - up to 60% improved, 12–15% stable, 20–30% worsened symptom course during pregnancy seems to be related to symptoms at conception. severe POTS more likely to decompensate	Table provided with overview of common POTS medications and their safety rating not medicated at conception likely to have less exacerbations of symptoms during pregnancy	Migraine, presyncope, syncope miscarriage rate same as general population 50–60% more likely to suffer hyperemesis gravidarum than the general public	Continuous fetal monitoring regional anaesthesia recommended early anaesthetic review recommended	Aim for vaginal birth when no obstetric complications consider caesarean section when mother is severely decompensated	-	Symptoms improve for majority within 6months - 1 year
2018	Morgan et Al	Systematic review	Variable - generally exacerbation in first trimester, improvement in second trimester, and variable third trimester	Medications not likely needed if not using at conception. continued use of medication during pregnancy seems to be linked with stable or improved symptoms beta blockers should be considered first line treatment	Large list of complications and adverse events though none linked directly to POTS comparable to that of the general population	Early anaesthetic review recommended closely monitor during labour	Vaginal birth recommended in absence of obstetric complications	-	6 months post-partum - 50-69% symptoms improved, 27–50% symptoms worsened 1 year post-partum - 10% symptom improvement, 40% stable, 50% symptoms worsened
2018	Ruzieh & Grubb	Clinical review	Variable - generally two thirds experience improved symptoms in the second and third trimesters, and one third worsened symptoms	Table provided with overview of common POTS medications and their safety rating treatment needs to be individualised	No statistical differences found except for higher rates of hyperemesis gravidarum	Anaesthetic decisions should be based on obstetric and surgical considerations, not POTS	Choose mode of delivery depending on obstetric considerations only	–	Majority experience stable symptoms breastfeeding should be encouraged due to oxytocin’s antidiuretic effect
2019	James & Burnett	Case report / 1	–	Metoprolol	–	Neuraxial spinal block and epidural infusion	Vaginal	Live birth, no complications to baby	–