Pregnancy and Benign Paroxysmal Positional Vertigo (BPPV)

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Benign paroxysmal positional vertigo (BPPV) is a condition of the inner ear that is characterized by the repeated occurrence of episodes of positional vertigo, a loss of balance that comes together with an illusionary sensation of rotation, or sliding, that is set off by changes in the position of the head relative to the direction of gravity. Known in the past, by various other terms, such as benign positional vertigo and paroxysmal positional vertigo, BPPV is not the same thing as dizziness. Dizziness is a kind of off-balance feeling related to lightheadedness, but vertigo specifically describes false, or exaggerated sensations of motion. The most common reason for vertigo is BPPV, which is a problem specifically with one of three fluid-filled curved structures within the inner ear called semicircular canals. Usually (in 85 to 95 percent of cases), the problem is in what doctors call the posterior semicircular canal, whereas most of the other cases involve the lateral semicircular canal (5 to 15 percent of cases). Less commonly, BPPV involves the anterior semicircular canal, or more than one semicircular canal at once.

BPPV is extremely common in people overall. In fact, it strikes about 2.4 percent of people at some point in life and BPPV accounts for 8 percent of cases of moderate to severe vertigo. Although BPPV occurs increasingly with advanced age, the condition tends to strike females twice as often as males. Changes in hormones may affect how vulnerable you are to the condition, which means that BPPV is common during pregnancy.

BPPV is thought to result from crystals of calcium carbonate (the substance that’s also the main component of chalk, eggshells, and pearls) getting bumped around and displaced into one of the semicircular canals from another part of the inner ear called the utricle. Apart from being the most common reason for vertigo, the main feature that distinguishes BPPV from many other inner ear conditions is that the person does not suffer any problems with hearing.

Suspicion that you have BPPV will be high if you experience sudden episodes of vertigo initiated by changing your head position relative to the direction of gravity. During physical examination, your doctor will be able to reproduce this vertigo by placing your head into particular positions, while the rest of your body is in different positions. During such maneuvers, the doctor will verify the presence of vertigo by observing what’s called nystagmus, a type of shifting of the eyes, and make other observations.

BPPV can make you suddenly nauseous, thereby exacerbating the nausea that comes early in pregnancy, and this can lead to vomiting. BPPV episodes also place you at risk of falling, a risk that increases during the latter half of pregnancy as your weight increases and your body’s center of gravity shifts, making walking more difficult. As for the baby, BPPV does not have any direct effects on the fetus. However, the fetus is at risk of being harmed in the event that BPPV leads you to fall.

Medications are available to dampen the response of your nervous system to head movements, the most commonly prescribed one being meclizine. Although there used to be some concern that this drug might harm the fetus, this medicine now is considered to be fairly safe. A drawback of meclizine, however, is that if your BPPV is fairly mild, or if your brain is adjusting already to the changed semicircular canal, it’s possible that meclizine can make your vertigo worse. As for breastfeeding, meclizine has not been studied extensively in terms of levels that can accumulate in breast milk and what it could do to an infant, but generally, the concern is very low that it cause a problem.

The main treatment for BPPV, other than waiting for the condition to resolve on its own, are special maneuvers that a doctor can perform, in which your head is rapidly moved into particular positions. One procedure is called the Epley maneuver and the other is called the Semont maneuver. In both procedures, the idea is to shift the crystals out of the affected semicircular canal, into other parts of the inner ear where they do not produce symptoms. If performed correctly, these procedures work better than medication.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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