POTS & Pregnancy: My 1st Trimester

*DISCLAIMER: I am not a medical professional.  What I am is someone who is living with POTS and has done an enormous amount of research.  That being said, every person is different.  Still too little is known about Dysautonomia and POTS and research into living with these conditions during pregnancy is even less prevalent.  Before taking anyone’s advice as gospel, be smart.  Know your body, and be open to opportunity.  

The Wednesday before Thanksgiving, I was finally on the mend from a sinus infection I’d picked up in Ireland. I was all set to pump my workout program to the next level, and safely increase my heart rate on a treadmill – vertically.  

I kicked ASS.  This workout made me feel pumped! I was BACK! Finally, with a heart rate brushing 170 bpm, breathing harder, and not feeling like the world was spinning, I started fantasizing about running again.  Maybe I could run a 5k next year! Maybe I could do one at Disney with my cousin! Maybe –

Then the world fell on it’s side.

I had finished my workout and had lowered the pace and elevation.  Within seconds, I was clutching the wall to hold myself up as I stumbled my way to the locker room.  

I didn’t understand what went wrong.  I was doing so well.  Had I pushed too hard? Had I gone too fast?  Was it too soon after being sick?

None of the above.

I was just pregnant.

We honestly didn’t think it would happen for us.

Fertility issues run in my family, likely based on our genetic trouble processing Vitamin B and Folic Acid, vital nutrients for supporting a growing fetus. A couple of the brave, incredibly strong women in my family battled with fertility issues for years.

I assumed I would be the same.  We had pretty much already written off having our own kids as an option.  We were both emotionally prepared to move beyond that realm of possibility.  

So when the pregnancy test I took as a precautionary measure over Thanksgiving weekend was positive, we were sincerely floored.  M, of course, was overjoyed.  He grinned for three days straight.  Meanwhile, I took a minute to come around.  A minute that I spent dry-heaving and having a panic attack in the hall bathroom while repeating “Oh my god… Ohhhhh my god… Oh. My. God.” 

We cried for a second, then I zipped my emotional walls back up.

I’d already talked to my cardiologist about pregnancy and POTS.  I’d already done the research and read what few studies there are.  

The first trimester, the risk of miscarriage is higher in POTS patients, especially in those above the age of 35.  A recent study from Vanderbilt University even suggests that POTS increases chances of endometriosis and uterine fibroids. Also high is the risk of hyperemesis gravidarum, the condition characterized by such severe morning sickness that it requires hospitalization.  The one that Princess Kate suffered from in all of her pregnancies.  Then, of course, there’s my family history. All of this could, of course, complicate efforts to get and stay pregnant.  So I knew better than to get attached.  

I did that super healthy thing that I do where I emotionally distance myself from things that could hurt me.  (Don’t worry, all that nonsense the government wants you to believe about making mental health care more accessible to veterans and military families is a bunch of hokum, so I’m pretty securely set into this particular habit. We’re friends now.  We exchange Christmas Cards and everything.)

In the meantime, I settled into figuring out how to navigate this whole pregnancy thing.

And you know, it really hasn’t been that bad.

Turns out, after two years of feeling nauseated and dizzy and having digestive issues and heart rate spikes and feeling absolutely exhausted for no reason, the first trimester of pregnancy is a piece of cake.  You’ve basically already been sharing your body with another force of nature anyway, so this really isn’t much different.

In POTS, you’re supposed to stay hydrated, avoid caffeine and alcohol, and eat small protein-rich meals four to five times a day.

In pregnancy, you’re supposed to stay hydrated, avoid caffeine, quit alcohol, and eat small meals five to six times a day.

In POTS, you get dizzy, nauseated, headaches, weak legs, fatigue, constipation, and sometimes presyncope or even syncope episodes.

In pregnancy, you get lightheaded, nauseated, headaches, swollen legs, fatigue, constipation, gas, and sometimes presyncope episodes.

So.  Yea.  Not too different.

But here’s a breakdown of how I settled in to a routine, just in case it helps you manage your symptoms.

EATING

1. Keep crackers next to the bed and have a couple before you go to sleep, and a couple when you wake up, before you even get up.  Do the same with a bottle of water.  It helps with the nausea.
2. EAT SMALL MEALS.  I’m not joking about this.  If you’re like me, digestive issues came with the POTS, and it got sooo much worse with pregnancy.  It’s gross, but this is the REAL STUFF, so if you’re looking for kosher, you came to the wrong place.  It was like a five band orchestra down there for the first few weeks.  You HAVE to eat small, frequent meals.  If I didn’t eat for more than three hours, I’d get unbelievably nauseated (though I never did actually get the relief of vomiting), gagging and dry heaving until I got something in my stomach.  But if I hate a full meal, I’d get so bloated and gassy that I was literally miserable, holding my belly and wishing for death for three hours.  So.  Don’t learn the hard way like I did.  Eat.  Small. Meals.  (Scroll to the bottom for a sample of what I’d eat in a typical day.)
3. You’re going to crave fatty, salty, carbs.  That’s ok, but it shouldn’t be your main food group.  Other options to soothe your acidic cranky tummy that won’t load you down and curse your partner for letting you eat so many servings of tater tots – Miso soup.  I know.  Surprising, but it’s salty and so so soothing on your tummy.  Also, bananas were great.
4. Don’t try to fight your food aversions.  For a solid month, the mere thought of raw vegetables sent my stomach into an Olympic interpretive dance routine.  It’s not going to help to try to trick yourself into “Mind Over Matter” – you’d just be needlessly torturing yourself.  Find other ways to get that nutrition – smoothies and soups worked well for me.
5. Don’t overeat.  I know I’ve said this before, but let’s take it in a different scope here – you should only be gaining at most 5-7 pounds in your first trimester.  So going whole hog and giving yourself free license to eat whatever you want isn’t the glory of pregnancy that you thought it would be (I know, I was bummed too).  You shouldn’t even be increasing how many calories you consume just yet, and if you do, you increase your risk of gestational diabetes.  Keep an eye on your sugar intake (might wanna think about switching to a different electrolyte drink if yours is high in sugar) and be careful that you don’t overdo it on the salt.  It’s a precarious balance, I know, you need the salt more than most people do, but your blood pressure may increase on it’s own so it’s just something to discuss with your doctor if you’re on a sodium supplement.
6. I’ve added a solid routine of apples, apple juice, oatmeal, and dates to my diet to help with the digestive upset.  Choose your poison wisely.  Prune juice made me sick and now I have trouble even thinking about it so don’t ruin your favorite things here, folks! Julie will not thank you! 

HYDRATING

1. I’ve actually had a lot more trouble with this than I ever thought possible.  I don’t like water anymore.  It’s the strangest thing, but I’m now hypersensitive to the chemicals and minerals in our tap water, and it literally makes me gag.  So I’m having to find other ways to stay hydrated, like herbal and decaf teas, bottled water, and fruit juices, in addition to the Nooma and Body Armor I drink everyday for electrolytes.  I also tried this make your own electrolyte drink recipe and it’s actually pretty good. I used both lemon and lime, and I think it’d be awesome with grapefruit too!
2. Additionally, I get full so easily now that I can’t imagine putting anything else into my body – including a liquid.  Cue eating more fruits like melon to get more water in my meals.

EXERCISE

1. All of my doctors have told me – KEEP EXERCISING.  So I am.  I’m just not doing it with the gusto that I did before.  
2. CARDIO – I’m not pushing my HR above 155 bpm – just keeping it a steady 125-145 bpm on a supine or upright bicycle for 30-45 minutes, depending on how I’m feeling that day.  And always keeping in mind that I still owe the puppers a 20-30 minute walk.  I made A LOT of progress with my exercise program, which I followed for about 10 months before I got pregnant, so I just took it back a teeny step, so as not to risk a syncope episode that could hurt both me and the kid.  I’d make sure to talk to your doctor about your progress before getting pregnant and how you should or shouldn’t continue.
3. STRENGTH – So far, the OB says I can continue with my regular strength and yoga routine.  She even said it’s encouraged.  So, two days a week, I do 20 minutes of yoga and 20-30 minutes of weight lifting, including a variety of squats, split squats, calf raises, bent over row, shoulder press, chest press, bicep curl, tricep curl, skull crushers, planks, bridges, and some hip strengthening pilate moves.  My cardiologist said not to push too hard on the standing routine, and if I get dizzy, just give it a rest for the day and move into the lying down routine.  The OB also said that I’d have to get creative into my second trimester with the lying down routine as she predicts POTS patients will be especially susceptible to the pressure that carrying the baby puts on your spine.

SLEEP

1. Do it.  All the time.  Where ever and whenever you can.  I had a couple weeks before finding my digestive sweet spot where I woke up at 3 or 4 in the morning starving to death for cereal and ice cold milk.  Or I was up late holding my belly and cursing the day that tater tots were invented.  But once I got into a routine, the pregnancy has really helped with my sleeping.  At the end of the first trimester, I was getting a solid 9 hours a night, and sometimes I’d even squeeze in a 20 minute snoozer in the afternoon.  Don’t deny yourself.  Your body is doing some pretty mind boggling things right now.  

Now that we’ve done the first appointment and the sonogram, miscarriage risk is down to 5%.  We’ve told our families, and we’ve started talking baby names and making plans, (and my belly is starting to make an appearance), things are slowly starting to sink in and I’m slowly pulling down the walls. Like I said before, pregnancy and POTS have such similar symptoms, that not much has really changed in my routine.  I have a minor crumb problem in my bed now because of late night and early morning crackers.  And my dog is basically velcroed to my hip now and gives me no mercy in cuddle time.  My husband leaps at the chance to grab me a glass of milk or do the dishes so he feels like he’s helping somehow (I let him – why not?) But other than that, all is well and life as normal.  I imagine this is a short-lived peace, so I’m just taking it in while I can still enjoy the silence.

(Oh, and I miss sushi.)

TYPICAL DIET (ie: what I ate on two separate days)

Roughly 1800 calories (you’ll need to find your own balance by looking up your own needs)

AM 1st thing: 2-4 Back to Nature wheat crackers and a couple swigs of water (every day of the 1st trimester)

Breakfast within 30 minutes of getting up: large bowl of melon, 1 slice whole wheat banana bread (It’s a whole wheat flour – paleo flour mix), 1 scrambled egg; OR 3/4 cup of plain whole milk yogurt with 1/2 cup mixed fresh berries and granola (I like Paleonola and bare naked brands)

AM mid-morning snack (2.5-3 hours later): 1/2 cup fresh berries, 1/2 cup plain whole milk yogurt, 2 tbs whole grain unsweetened granola; OR 1 slice whole wheat bread, 1 tbs no sugar added nut butter, sprinkle of cinnamon, 1/2 banana or small apple

Lunch (2.5 hours after your snack): Tuna sandwich – light chunk tuna salad (avocado mayo, lemon juice, s&p), dill pickle chips on 1 slice of whole wheat bread, w/ baby carrots & cucumber slices; OR whole wheat tortilla with 1 tbs hummus, sliced cucumbers, tomatoes, leafy greens, onion, and bell pepper with red wine vinegar, olive oil, S&P, Oregano

PM mid-afternoon snack (2.5-3 hours later): apple w/ unsweetened almond butter; OR small handful of lightly salted mixed nuts

Dinner (2.5 hours after your snack):  Homemade easy garden vegetable soup, 1/2 grilled cheese on whole wheat bread; OR CauliRice stir fry w/ snap peas, broccoli slaw, bean sprouts, and carrots (add chicken if you’re extra hungry) — DON’T FORGET TO TAKE YOUR PRENATAL NOW!

Late night snack: small bowl of bran cereal with sliced banana or blueberries and unsweetened coconut almond milk or crackers with peanut butter