Navigating Pregnancy with Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorder (HSD)

What to Expect & How to Prepare for a Healthy Pregnancy

Pregnancy is a life-changing experience, but for those with Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorder (HSD), it can come with added challenges. These conditions affect connective tissue, joint stability, cardiovascular function, and digestion, all of which are influenced by pregnancy-related changes.

The good news? With the right preparation, expert guidance, and proactive symptom management, many individuals with hEDS/HSD can experience a healthy pregnancy and successful postpartum recovery. This guide will walk you through key considerations—from pre-conception planning to postpartum recovery—to help you feel confident and supported throughout your journey.

Preparing for Pregnancy with hEDS/HSD

Build a Multidisciplinary Care Team

Because hEDS and HSD impact multiple body systems, assembling a team of specialized healthcare providers before conception can make a significant difference in your pregnancy experience. Your team may include:

• High-Risk Obstetrician – To monitor pregnancy-related complications

• Geneticist – Since hEDS is inherited in an autosomal dominant pattern

• Cardiologist – To track blood pressure and heart function, especially with POTS

• Physical Therapist (PT) Specializing in Hypermobility – To improve joint stability and prevent pain

• Gastroenterologist – To help manage digestive issues, which can worsen during pregnancy

Research suggests that mast cell activation plays a role in inflammation for individuals with hEDS, potentially increasing pregnancy-related complications (Theoharides et al., 2015). Working with a knowledgeable team can help you mitigate risks.

Optimize Medications & Supplements

Not all medications used to manage pain, dysautonomia, and gastrointestinal symptoms are safe during pregnancy. Work with your doctor to adjust medications as needed.

• Pain Management: Avoid NSAIDs in later pregnancy, as they can lead to premature ductus arteriosus closure (Rathmell et al., 2008). Alternatives like physical therapy, gentle exercise, and acupuncture may help.

• Nutritional Deficiencies: Many individuals with hEDS have low Vitamin D, B12, and iron, which can lead to fatigue and joint instability (Castori et al., 2012). Optimizing these levels before pregnancy may prevent complications.

• Hydration & Electrolytes: Increasing fluid and salt intake can help manage POTS symptoms, which may worsen with pregnancy-related blood volume changes (Benarroch, 2012).

Strengthen & Stabilize Your Joints

A targeted stability and strengthening program before pregnancy can reduce pain and instability. Recommended approaches include:

• Pelvic floor therapy – To prevent pelvic pain and instability (Albert et al., 2006)

• Low-impact exercises like swimming, Pilates, and resistance training – To build strength without overstressing joints

• Postural training – To minimize strain on hypermobile joints

Managing Pregnancy Symptoms with hEDS/HSD

How Pregnancy Affects Joint Hypermobility & Dysautonomia

During pregnancy, hormones like relaxin and progesterone increase ligament laxity, which can worsen joint instability and dysautonomia symptoms. Common challenges include:

• Joint Subluxations & Dislocations – Increased laxity can make joints more prone to misalignment.

• Pelvic Girdle Pain (PGP) & Symphysis Pubis Dysfunction (SPD) – Hormonal changes can destabilize the pelvis (Albert et al., 2006).

• Muscle Spasms & Postural Imbalances – Changes in weight distribution can lead to increased muscle tightness and strain.

• Dizziness & Fatigue – Dysautonomia symptoms, including POTS-related fainting and low blood pressure, may worsen.

Musculoskeletal Support Strategies

To manage joint and muscle discomfort, consider: 

• Wearing a pelvic support belt – Helps stabilize the pelvis and reduce pain (Albert et al., 2006). 

• Making ergonomic adjustments – Proper posture can minimize joint strain. 

• Incorporating gentle stretching & strengthening exercises – Focus on core stability and joint control without overstretching. 

• Seeking prenatal physical therapy – A PT specializing in hypermobility can provide customized exercises for pain relief and stability.

Regulating Cardiovascular & Autonomic Function

Pregnancy can amplify the circulatory challenges associated with hEDS and POTS, particularly as changes in blood volume affect blood pressure regulation. To manage these shifts, staying hydrated is key—electrolytes and water help stabilize blood pressure (Benarroch, 2012). In addition, compression stockings can enhance circulation and reduce swelling, while modifying exercise routines to include safer activities like stationary cycling or swimming helps maintain fitness without overtaxing the body. Regular blood pressure monitoring is also crucial, as your doctor may need to adjust fluid intake, salt levels, or medications to manage symptoms effectively.

Labor & Delivery Considerations

Choosing the Best Labor Positions for Joint Protection

Labor and delivery put immense strain on the body, and for those with hEDS or HSD, the wrong position can increase pain and instability. Side-lying or hands-and-knees positions are often the best choices, as they help reduce pressure on the pelvis and lower back while promoting better alignment. On the other hand, extreme hip abduction (wide-leg positions) should be avoided, as it can overstretch already lax ligaments and lead to long-term discomfort. Another key strategy? Perineal support during delivery, which has been shown to lower the risk of tearing (Berghella et al., 2008), offering extra protection for delicate connective tissues.

Pain Management: What Works Best for hEDS?

Managing labor pain can be tricky when local anesthetics don’t always work as expected (Hakim et al., 2017). That’s why it’s essential to discuss anesthesia options early with your care team to avoid surprises. For natural pain relief, water immersion is a game-changer—warm water can help ease joint strain, reduce muscle tension, and create a more comfortable birthing experience. Additionally, controlled breathing techniques not only help with pain management but also prevent unnecessary stress on already unstable joints, keeping you as comfortable and in control as possible throughout labor.

Postpartum Recovery: Healing, Strength, and Stability

Bringing a baby into the world is a monumental experience—but recovery is just as important, especially for those with hEDS or HSD. The postpartum period requires careful attention to pelvic stability, joint support, and overall well-being to ensure a smooth transition into motherhood.

Rebuilding Strength: Pelvic Floor & Joint Rehabilitation

Your body has been through a lot, and gentle, targeted recovery strategies can help you regain stability and prevent long-term complications:

• Pelvic floor physical therapy – Strengthening these muscles can prevent incontinence and prolapse (Hagen et al., 2011).

• Gradual core strengthening – A slow, controlled return to movement restores posture and joint control.

• Bracing or taping techniques – Provides extra joint support in the early stages of postpartum recovery.

Breastfeeding Without the Pain

Nursing may be a bonding experience, but it can also wreak havoc on your neck, shoulders, and back—especially if you’re already dealing with joint instability. A few ergonomic adjustments can make all the difference:

• Use ergonomic seating & nursing pillows – Proper support helps prevent unnecessary strain.

• Try side-lying positions – This reduces pressure on the arms and shoulders, making feeding more comfortable.

Prioritizing Mental & Emotional Health

Postpartum hormone shifts, sleep deprivation, and chronic illness can increase the risk of anxiety or depression. Taking proactive steps to support your mental health is just as crucial as physical recovery:

• Talk to a mental health professional – Someone familiar with chronic conditions can provide guidance.

• Join support groups – Connecting with other parents who have hEDS/HSD can be incredibly validating.

• Prioritize self-care & pacing – Avoid burnout by listening to your body and adjusting activity levels as needed.

Key Takeaways

• Pre-pregnancy preparation helps manage joint instability, cardiovascular function, and inflammation.

• Proper labor positioning and pain management can protect joints and minimize complications.

• Postpartum recovery should focus on pelvic floor health, core stability, and gradual strengthening.

Pregnancy & postpartum recovery is a journey, but with the right support, strategies, and self-care, you can heal, regain strength, and fully enjoy this new chapter of life. If you need expert guidance tailored to the unique challenges of hEDS, hypermobility, POTS, or Mast Cell Activation Syndrome, ActifyPT is here to help. As the leading regional provider of specialized physical therapy for connective tissue disorders, we offer personalized, one-on-one care to support you through pregnancy, childbirth, and postpartum recovery. 

Contact ActifyPT today to schedule a consultation and take the next step toward a healthier, stronger journey into motherhood.