From the Guidelines
Vertigo in pregnancy is typically managed with conservative measures, and the most effective approach is to avoid sudden movements, stay hydrated, and practice good sleep hygiene, as evidenced by the 2017 clinical practice guideline on benign paroxysmal positional vertigo 1. The causes of vertigo in pregnancy can be attributed to hormonal changes affecting the inner ear or blood pressure fluctuations, and it is essential to rule out other potential causes like benign paroxysmal positional vertigo (BPPV) or more serious conditions that may require specific treatment. Some key points to consider in managing vertigo in pregnancy include:
- Avoiding sudden movements, especially when changing positions
- Staying hydrated and eating small, frequent meals to maintain blood sugar levels
- Practicing good sleep hygiene and getting adequate rest
- Trying gentle exercises like prenatal yoga or walking to improve balance
- Using support devices like a cane or walker if balance is significantly affected If symptoms are severe or persistent, it is crucial to consult an obstetrician for a thorough evaluation, and they may recommend vestibular rehabilitation exercises or prescribe meclizine (25mg every 6-8 hours as needed) for short-term relief, as suggested by the clinical practice guideline 1. It is also important to note that BPPV is a common vestibular disorder that can occur during pregnancy, and its diagnosis and treatment should be guided by the most current evidence base, as outlined in the 2017 clinical practice guideline on benign paroxysmal positional vertigo 1. In terms of diagnosis, the guideline recommends a thorough clinical evaluation, including a review of the patient's medical history, physical examination, and diagnostic tests such as the Dix-Hallpike test and supine roll test, to determine the underlying cause of vertigo and develop an effective treatment plan 1. Overall, the management of vertigo in pregnancy should prioritize conservative measures and aim to improve the patient's quality of life, while also ruling out other potential causes and developing an effective treatment plan based on the most current evidence base, as recommended by the clinical practice guideline on benign paroxysmal positional vertigo 1.
From the FDA Drug Label
8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Risk Summary: Data from epidemiological studies have not generally indicated a drug-associated risk of major birth defects with meclizine during pregnancy.
The causes of vertigo in pregnancy are not specified in the drug label. The management of vertigo in pregnancy is not directly addressed in the label, but meclizine may be used in adults for the treatment of vertigo associated with diseases affecting the vestibular system.
- However, the label does mention that data from epidemiological studies have not generally indicated a drug-associated risk of major birth defects with meclizine during pregnancy 2.
- It is recommended to use meclizine with caution in pregnant women, considering the potential risks and benefits.
From the Research
Causes of Vertigo in Pregnancy
- Vertigo in pregnant females may be associated with hormonal changes in peripheral structures and inner ear organs 3, 4
- Meniere's disease, vestibular migraine, and benign paroxysmal positional vertigo are usually exacerbated during pregnancy 3, 4
- Hormonal changes and modifications in vascular dynamics are typical causes of vertigo during pregnancy 5
- Pathophysiological mechanisms involving vestibular and central nervous system adaptations may contribute to the development of vertigo 5
Management of Vertigo in Pregnancy
- Numerous alternatives for treatment are available, including dietary changes, vestibular therapy, medicines, and surgical procedures 5
- Non-pharmacological interventions such as cognitive behavioral therapy, vestibular rehabilitation, and dietary modifications may be effective in managing vertigo 6, 7
- Vestibular rehabilitation therapy, cognitive behavioral therapy, and non-invasive vagal nerve stimulation are effective in the management of persistent postural-perceptual dizziness patients, which may also be applicable to pregnant women with vertigo 7
Specific Considerations
- Specific changes to hearing and proprioception in the physical examination are also noted between the second and third trimester of pregnancy 3, 4
- Some types of vertigo may be exacerbated and others may present at any time of pregnancy 3, 4
- Understanding audio-vestibular symptoms' pathological and clinical relationship during pregnancy requires more study 3, 4