Pregnancy with hEDS & Hypermobility Spectrum Disorders: Evidence-Based Guidance for Every Stage

Pregnancy places incredible demands on the body — and for individuals with hypermobile Ehlers-Danlos Syndrome (hEDS) or Hypermobility Spectrum Disorders (HSD), those demands can feel even more complex. Joint instability, pain, fatigue, and connective tissue differences can all influence the pregnancy and postpartum experience.

Fortunately, new evidence-based clinical guidelines now offer clearer direction. A recent scoping review titled “Management of Childbearing with Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders” brings together the best available research and expert consensus — including lived patient experience — to support safer, more individualized care.

At Intrinsic Physical Therapy, we use these guidelines to help patients with hEDS and HSD feel informed, empowered, and supported throughout pregnancy and beyond.

Understanding Pregnancy Risks with hEDS and HSD

People with hypermobility often worry about pregnancy complications — and while some risks are increased, many individuals with hEDS or HSD experience healthy pregnancies with the right care.

Common considerations include:

• Joint pain and instability

• Pelvic girdle pain

• Fatigue and autonomic symptoms

• Slower tissue healing postpartum

The guidelines emphasize that routine high-risk interventions are not automatically required. Instead, care should be individualized, proactive, and multidisciplinary.

Pre-Pregnancy Planning: Why Physical Therapy Matters

Preconception care is especially valuable for individuals with hypermobility disorders.

Evidence-based recommendations include:

• Screening for musculoskeletal stability, pain patterns, and functional limitations

• Identifying comorbid conditions (such as dysautonomia or GI concerns)

• Optimizing strength, joint control, and endurance before pregnancy

Physical therapy before pregnancy can help improve joint support, reduce pain flare-ups, and prepare your body for the changing demands of pregnancy.

Managing hEDS & HSD During Pregnancy

Hormonal changes — particularly increased relaxin — can amplify joint laxity during pregnancy. For individuals with hypermobility, this may lead to increased symptoms as pregnancy progresses.

Guideline-supported strategies include:

• Ongoing symptom monitoring rather than blanket restrictions

• Avoiding unnecessary bed rest, which can worsen instability and deconditioning

• Collaborative care between obstetrics, physical therapy, and other specialists

Pregnancy-specific physical therapy can support:

• Pelvic and core stability

• Joint protection strategies

• Pain management through movement, positioning, and gentle strengthening

Labor and Delivery Considerations for Hypermobility

Labor and birth planning is an important part of care for people with hEDS and HSD.

Key recommendations include:

• Discussing joint protection and positioning during labor

• Using supportive props to reduce strain on hips, knees, and spine

• Early communication with anesthesia providers, as some individuals may respond differently to pain medications

Mode of delivery — vaginal or cesarean — should be based on individual health factors, not diagnosis alone.

Postpartum Recovery with hEDS or HSD

The postpartum period is often overlooked — but it is critical for long-term health, especially with connective tissue disorders.

Evidence-based postpartum considerations include:

• Allowing extra time and support for wound healing

• Monitoring pelvic floor symptoms and joint instability

• Addressing the physical demands of infant care and feeding

Postpartum physical therapy can help restore core and pelvic floor function, improve joint stability, and support a safe return to daily activities.

Why These Guidelines Are a Game-Changer

While research on pregnancy and hypermobility is still emerging, these guidelines represent the most comprehensive, patient-centered recommendations available to date. They highlight the importance of:

• Shared decision-making

• Individualized care plans

• Early involvement of physical therapy

For patients with hEDS and HSD, this means fewer assumptions — and more informed, supportive care.

How Intrinsic Physical Therapy Can Help

At Intrinsic Physical Therapy in Golden Valley, MN,, we specialize in treating hypermobility across the lifespan — including pregnancy and postpartum care.

We support patients with:

• Pre-pregnancy preparation

• Pregnancy-specific physical therapy

• Postpartum recovery and return to function

If you’re pregnant, planning pregnancy, or newly postpartum with hEDS or Hypermobility Spectrum Disorder, we’re here to help you move with confidence.

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