Managing dizziness during pregnancy
Feeling dizzy during pregnancy is common. Your body is changing in many ways. Your blood pressure, hormones, fluid levels, sleep, posture, and balance can all change. But dizziness should not always be brushed off as “just pregnancy.” Sometimes, dizziness is caused by a balance problem in the inner ear or brain. These problems can often be treated safely with the right care.
A recent medical review looked at how vestibular disorders can be managed during pregnancy. The authors explain that pregnancy can make dizziness harder to understand because many symptoms overlap with normal pregnancy symptoms, such as nausea, lightheadedness, and feeling unsteady.
Why does pregnancy affect balance?
During pregnancy, your vestibular system has to work harder to adjust to the changes your body is going through. This can make you feel off-balance, lightheaded, or more sensitive to motion.
You may feel off-balance or dizzy because of:
- A changing center of gravity
- Hormone changes
- Blood pressure changes
- More fluid in the body
- Posture changes
- Nausea and fatigue
Some people may also have a vestibular condition that begins or worsens during pregnancy. This may increase feelings of imbalance, vertigo, or lightheadedness.
Vestibular Conditions During Pregnancy
The medical review linked earlier in this article focused on vestibular migraine, BPPV, Ménière’s disease, PPPD, and vestibular neuritis during pregnancy. Pregnancy can affect any vestibular condition though, so talk with your doctor to get support based on your needs.
It is also important to know that vestibular conditions during pregnancy are understudied. The information below is limited, so please talk with your providers about how your vestibular condition affects your pregnancy and vice versa.
BPPV during pregnancy
BPPV happens when tiny crystals in the inner ear move into the wrong place. This can cause brief vertigo episodes, nausea, or imbalance. Testing for BPPV is safe and non-invasive. You can talk with your provider to find testing positions that are comfortable for you during your pregnancy. You can always ask to modify positions or stop if you feel too uncomfortable.
If you are diagnosed with BPPV during pregnancy, the good news is that it can often be treated without medication. A trained provider may use special head and body movements, called repositioning maneuvers, to move the crystals back where they belong.
These movements can be changed to keep you comfortable and safe during pregnancy. There are several maneuvers and modified positions that can be used for different needs. Later in pregnancy, you may be advised not to lie flat on your back for too long. Pillows, wedges, or side-lying positions can be used instead.
Vestibular Migraine during pregnancy
Vestibular migraine can cause dizziness, vertigo, motion sensitivity, nausea, light sensitivity, sound sensitivity, or headaches. Some people have dizziness even without a strong headache. Pregnancy may make migraine symptoms better, worse, or different. For some people, headaches improve but dizziness continues.
If you are getting tested for vestibular migraine during your pregnancy, it is important to know that there is no single test to diagnose you. Your provider makes the diagnosis by looking at your symptoms, your health history, and any exams they deem necessary.
Treatment of vestibular migraine during pregnancy can include:
- Regular sleep
- Eating on a steady schedule
- Drinking enough fluids
- Avoiding known triggers
- Managing stress
- Vestibular therapy, when appropriate
If you are having trouble following these treatments while pregnant, talk with your provider. Some medicines may be considered if symptoms are severe, but this should be discussed with your pregnancy care provider or medical team.
Ménière’s Disease during pregnancy
Ménière’s disease can cause episodes of vertigo, hearing changes, tinnitus, and ear fullness. There is no single test to diagnose Ménière’s, so it is important that you talk with your doctor to find out if certain tests may be better than others during pregnancy.
If you have been diagnosed with Ménière’s and you are pregnant, treatment usually starts with safer, non-medicine steps. These may include staying hydrated, reducing known triggers, and following diet changes if recommended by a provider.
Vestibular rehabilitation therapy is also an option:
Some medicines used for Ménière’s disease outside of pregnancy may not be the best choice during pregnancy. A provider should help weigh the risks and benefits.
PPPD during pregnancy
PPPD can cause ongoing dizziness, rocking, swaying, or unsteadiness. Symptoms may feel worse when standing, walking, moving, or looking at busy places like stores, traffic, or scrolling screens. It is usually diagnosed by talking about symptom history with your provider and using lab tests or imaging to rule out other causes. Discuss your pregnancy with your provider before proceeding with testing.
The good news is that there are multiple ways to safely treat PPPD during pregnancy. Treatment can include education, vestibular therapy, gentle exposure to movement, and support for anxiety or fear of symptoms. Support may include meeting with a psychologist who has been trained to help people with PPPD.
The goal is to help the brain feel safe with movement again. This can be harder during pregnancy as your balance changes, so be kind to yourself, move slowly, and talk with people who can support you, including your clinicians, family, and friends.
Vestibular Neuritis during pregnancy
Vestibular neuritis is irritation or inflammation of a balance nerve. It can cause sudden, strong vertigo, nausea, vomiting, and trouble walking. This can feel scary, especially during pregnancy, but many people improve over time.
A provider will diagnose you based on your symptoms, eye movements, balance, and hearing. There are a variety of tests that can be performed to diagnose vestibular neuritis, so talk to your provider about which ones they would like to do and how your pregnancy may affect this decision.
During pregnancy, vestibular therapy can help the brain adjust and recover. Medicines for dizziness treatment may not be the best option while you are pregnant, so any medication-related care should be guided by your provider.
Treatment often depends on the trimester
It is important to know that care may change depending on how far along someone is in pregnancy. Talk with your care team as your pregnancy progresses to make sure you are getting the best treatment for your situation.
- In the first trimester, providers are usually extra careful with medicines. Non-medicine treatments are often preferred.
- In the second trimester, some treatments may be easier to tolerate. Vestibular therapy and careful testing may be helpful.
- In the third trimester, positioning matters more. Providers may avoid having someone lie flat on their back for too long. They may also focus more on fall prevention, comfort, and safe movement.
Where can I find care for my dizziness?
If you believe your dizziness may be related to a condition besides pregnancy, it may be helpful to:
- Talk with your doctor for a referral
- Use Dizzy Care Network to find a clinician
- Browse other resources to look for support.
When should I get urgent medical help?
Seek urgent medical care right away if dizziness happens with:
- A fever of 100.4℉ or higher
- Severe belly or chest pain
- Vaginal bleeding or fluid leaking
- Severe nausea or vomiting (worse than morning sickness)
- Redness, pain, warmth, or swelling in one leg
- Your baby is moving less than usual or has stopped moving
- Thoughts of hurting yourself or your baby
- Trouble breathing or speaking
- Fainting
- Weakness on one side
- New vision changes
- A severe headache
- Sudden hearing loss
Key Points
- Dizziness during pregnancy is common, but it should not always be brushed off as “just pregnancy.”
- Pregnancy changes the body in ways that can affect balance.
- Vestibular conditions can be treated during pregnancy.
- Treatment may need to change depending on the trimester, so it is important to talk with your care team as your pregnancy progresses.
- Medicines should be used carefully and only with guidance from your provider.