BPPV and pregnancy
Reviewed by Yovina Khiroya-Morjaria

This narrative review explores the limited evidence surrounding benign paroxysmal positional vertigo (BPPV) during pregnancy. Although BPPV is the most common vestibular disorder and is known to affect women more frequently than men, the literature specifically examining its occurrence in pregnancy is remarkably sparse. The authors identified only 5 studies describing a total of 20 cases. Across these reports, posterior semicircular canal involvement was the most common presentation, consistent with the broader BPPV literature. Diagnosis relied primarily on positional testing, particularly the Dix–Hallpike manoeuvre, while treatment largely consisted of canalith repositioning manoeuvres such as Epley or Semont. Importantly, these manoeuvres were reported to be well tolerated in pregnancy when performed with appropriate care. The review also explores potential mechanisms linking pregnancy and BPPV. Hormonal fluctuations, particularly involving oestrogen, may influence otoconial stability, while alterations in calcium and vitamin D metabolism during pregnancy may also contribute. Positional factors, such as prolonged bed rest or sleeping on the left side, are proposed but remain speculative. For clinicians, the paper offers useful reminders that the core diagnostic and treatment principles for BPPV remain applicable in pregnancy, although positional modifications may be required in later gestation to avoid supine hypotensive syndrome. From a clinical perspective, the discussion around vitamin D and calcium metabolism is particularly interesting, given the growing evidence linking deficiency with recurrent BPPV. Ultimately, this review highlights how little structured research exists in this area and reinforces the need for larger prospective studies. For clinicians working in vestibular or audiology settings, it provides a concise overview of a clinical scenario that, while uncommon, is likely under-recognised.

Benign paroxysmal positional vertigo during pregnancy: A narrative review.
Franz L, Marioni G.
HEAR BALANCE COMMUN
2025;23(4):159–63.