Postural orthostatic tachycardia syndrome (POTS) is an autonomic condition characterized by the presence of a >30 bpm increase in heart rate, accompanied by orthostatic symptoms, including heart palpitations, light-headedness, weakness, blurred vision, nausea, and headache. Females are commonly affected by POTS at childbearing age. This case series aims to compare the clinical presentations, autonomic dysfunction management, and pregnancy outcomes of four women with POTS. In our autonomic neurology clinic, the goal for our patients is consistent blood pressure during pregnancy. The patients were all interviewed retrospectively to determine pregnancy outcomes. Our study indicates the need for neurologists to collaborate with a team of maternal-fetal medicine specialists with advanced training in high-risk pregnancies to optimize autonomic function throughout the course of pregnancy. In addition, our results suggest that reducing medications to minimize harm can be achieved through regular monitoring at 1 – 3 month intervals during pregnancy, with a 6-week postpartum evaluation.