The following review analyzes the use of meclizine therapy during pregnancy -“Treatment Options for Nausea and Vomiting During Pregnancy” (Pharmacotherapy.  2006;26(9):1273-1287).

Abstract

“In a meta-analysis of more than 24 controlled studies from 1960-1991 involving more than 200,000 pregnant women, antihistamines (specifically H₁-blockers) given during the first trimester did not increase teratogenic risk. The authors concluded that antihistamines can be safely prescribed for women with NVP. Relative risk of exposure in this study was 0.76 (95% confidence interval 0.60-0.94), suggesting that H₁-blockers may be associated with a protective effect. It is not known whether this protective effect was purely secondary to the antihistamine prescribed and its potential for better metabolic conditions to the fetus leading to reduction of birth defects. Also unknown is whether pregnancies characterized by vomiting are associated with better pregnancy outcomes for other reasons. Further studies are necessary to verify the possibility of a protective effect from H₁-blockers.

Meclizine was evaluated in three large prospective studies to assess for teratogenicity. In all three studies, meclizine therapy was compared with no drug therapy during pregnancy; rates of malformations in the drug therapy and no drug therapy groups were not statistically different. In a large collaborative perinatal project, diphenhydramine (595 women) and dimenhydrinate (319 women) administered during the first trimester of pregnancy was not associated with major or minor malformations. In addition, two reports concerning antihistamines prescribed during pregnancy to treat asthma and allergic symptoms found that diphenhydramine and dimenhydrinate carried a low teratogenic risk.” PMID:16945050

The following review concludes that meclizine can be used safely for nausea and vomiting in pregnancy -“Delivery outcome after the use of meclozine (sic) in early pregnancy” (Eur J Epidemiol. 2003;18(7):665-9).

Abstract

“In some countries, including Sweden, no risk is considered to exist with the use of meclizine for nausea and vomiting in pregnancy (NVP), but in other countries warnings against use during pregnancy are given. Rat tests indicate a teratogenic risk and published epidemiological studies are of restricted size.

Delivery outcome was studied in 16,536 women who reported the use of meclizine in early pregnancy and was compared with all 540,660 women who gave birth. Information on drug usage was obtained prospectively in early pregnancy. Risk factors for using meclizine were young maternal age, to have had a previous child, not to smoke, to have a low body mass index. The use of some other drugs (antihypertensives, thyroxine, anticonvulsants) decreased the use of meclizine. Maternal diagnoses of preeclampsia or diabetes were less frequent when the woman had used meclizine. The twinning rate was increased and the sex distribution of the infants low (female excess). Preterm birth, low birth weight, short body length, and small head circumference occurred at a reduced rate after meclizine use, notably for boys. Also the rate of congenital malformations was reduced.

If anything, delivery outcome is better than expected when the mother used meclizine. These beneficial effects are probably secondary to NVP. Meclizine can apparently be used without risk at this condition.” PMID: 12952140

We can compound meclizine into a transdermal cream that can be applied directly to the wrist.

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