Benign paroxysmal positional vertigo during pregnancy: A narrative review

Abstract Benign paroxysmal positional vertigo (BPPV) is the most common vestibular vertigo disease. BPPV has a clear female prevalence, with a female-to-male ratio ranging from 2:1 to 3:1. In the case of BPPV occurrence in a pregnant woman, vestibular impairment acts in a complex context, in which patients experience coexisting anthropometric, cardiovascular, hormonal, and psychological changes. The aim of this review has been to critically discuss the current knowledge regarding BPPV during pregnancy. The electronic databases Scopus and PubMed and Web of Science were searched from database inception to October 5, 2025. Five original reports described BPPV cases occurring during different stages of pregnancy. Overall, 20 cases of BPPV in pregnant women were reported. Several hypotheses underlying BPPV occurring during pregnancy have been proposed, including prolonged bed rest or sleeping on the left side. A role of hormonal alterations during pregnancy has also been considered. Furthermore, BPPV occurrence during pregnancy could be related to Vitamin D deficiency and calcium metabolism disturbances due to increased calcium reabsorption in many systems and increased metabolic demands of the fetus. Positional testing is crucial for the diagnosis of BPPV also in the pregnancy setting. The management of BPPV during pregnancy was primarily based on repositioning maneuvers. In advanced gestation, modified positioning or the use of side-lying alternatives could be advised, to accommodate uterine size and prevent supine hypotensive syndrome. Pharmacological therapy is generally discouraged. Currently, the available data regarding BPPV during pregnancy are quite sparse. Further multicenter studies are advocated to obtain stronger evidence.