Pregnancy and travel

If you are pregnant, the safest time for you to travel, generally speaking, is during the second trimester, provided you aren’t experiencing any complications.

If you are pregnant and considering travel, you must consult with your doctor, especially if your pregnancy is high risk. Consider the standard of medical care at your chosen destination, just in case you need help.

Some countries have reciprocal healthcare arrangements with United States – check with Medicare. Travelling to developing nations is not encouraged during pregnancy for various reasons, including the risk of disease and the lower standard of medical facilities compared to United States. Pregnant women experiencing complications are advised not to travel.

Some complications include: prior premature labour

If you are aged 35 years or over and pregnant for the first time, you are also advised not to travel. Travellers to most developing nations need to be immunised against diseases such as typhoid. Most vaccines are either dangerous to unborn babies or haven’t been adequately tested for safety on pregnant women.

The important exception to this is the influenza vaccine, which can be safely given during pregnancy. It is strongly recommended for all pregnant women, as influenza in pregnancy can be a very serious illness. Generally, all live virus vaccines (such as mumps and measles) should be avoided during pregnancy.

Some vaccines, such as for yellow fever, may cautiously be given after the first trimester.

Be advised by your doctor

It is recommended that pregnant women delay any travel to developing nations until after their babies are born. Malaria is an infection carried by particular species of mosquito. A pregnant woman who catches malaria risks miscarriage, premature labour and stillbirth.

Some antimalarial drugs (such as chloroquine) are considered safe to take during pregnancy, but others (such as doxycycline) are potentially harmful to the unborn baby. It is recommended that pregnant women avoid travelling to areas where malaria is present. Long periods of not moving during car, bus, rail and air travel increases the risk of clots forming in the deep veins of the leg, known as deep vein thrombosis (DVT).

These clots can circulate and lodge in parts of the body such as the lungs. The risk of DVT is increased in pregnancy if: a family member has had a DVT. One in 1,000 pregnant women will develop DVT. Research indicates the risk of DVT can increase by two or three times in a long-distance flight.

There is no research-based advice on travel for pregnant women

However, if you choose to travel long distances, you should: Do frequent leg exercises. Walk regularly (in the case of air travel, walk around the aircraft cabin if the flight is smooth).

Avoid dehydration by drinking plenty of water

Minimise alcohol and caffeine intake

If you have an increased risk of DVT, you are advised to: Discuss travel plans with your doctor. Wear well-fitting elastic below-knee compression stockings during the journey. Receive heparin injections before and after any journey longer than four hours.

Before you decide to travel by plane: Discuss any potential risks particular to your pregnancy with your doctor.

For example, a woman with gestational diabetes or a multiple pregnancy is generally advised not to fly. Be aware that air travel in the last six weeks of pregnancy could trigger premature labour.

Check the fine print of your travel insurance – some policies may not cover pregnancy. Arrange with the airline for a bulkhead seat or a seat near an exit for extra leg room.

Consider booking an aisle seat – going to the toilet will be a little easier.

Before you leave, discuss with your doctor whether you need to travel with a medical kit. Remember to pack this kit in your carry-on luggage so you can access it during the flight.

Items your medical kit could contain: preparations to help you treat common pregnancy complaints such as heartburn, thrush, constipation and haemorrhoids urine dipsticks to check glucose levels (if required).

During the flight: Wear your seatbelt under your bump and across your lap

Stretch and move your legs regularly while seated

Consider wearing support stockings for the duration of the flight. A pregnant woman’s circulation is already under strain – the lower cabin pressure inside a plane can theoretically increase the risk of blood clots. Drink plenty of water to reduce the risk of dehydration.

Keeping up your fluid intake will also reduce the risk of DVT.

If the flight is smooth, walk up and down the aisles every half hour. If the flight has turbulence, stay in your seat, but flex and extend your ankles frequently.

If you are feeling short of breath or light-headed, ask one of the flight attendants to give you breathing oxygen.

If travelling by car: Make frequent breaks to stretch your legs and visit the toilet.

Always wear a seatbelt

Fasten the lap sash across your lap and under your bump, fit the shoulder sash above your bump and between your breasts. Avoid wearing the lap sash across your bump as a sudden jolt could cause your placenta to separate from your uterus.

If you are sitting in the front passenger seat, move your seat well back from the dashboard to reduce airbag impact in case of a collision.

If you are driving, have your seat as far back from the steering wheel as possible, while still being able to drive safely and comfortably.

It may help to tilt the steering wheel downwards, away from your belly

If you are involved in a collision, however minor, see your doctor.

If you have contractions, pain or bleeding after an accident, see a doctor as soon as possible. Let them know if you have a blood group, as you may need to have an anti-D injection. Consider joining a roadside assistance program that can help you in case of a breakdown, and always carry a mobile phone.

If travelling in hot weather: Carry a water bottle with you and drink water frequently. Stay in the shade or inside during the hottest part of the day. Protect your skin by wearing loose-fitting clothing, a hat and sunscreen.

Avoid rushing or overexertion – plan your activities and give yourself plenty of time.

If you feel weak and dizzy, light-headed or even slightly nauseous, it may be a sign that you are overheating and dehydrated. Remember: to bring down your temperature by using a fan, placing a cool, wet cloth on your forehead and the back of your neck, or running cool water over your wrists.

Certain sporting activities carry an increased risk to your unborn baby. Activities to avoid include: Water-skiing – coming off the skis could force water into the vagina.

Scuba diving – the changes in blood gases may harm your baby. Snorkelling is fine and scuba diving to depths of less than 18 metres (60 feet) is reasonably safe, but check with your doctor first. Saunas and hot tubs – raising your body temperature can harm your baby.

Horseback riding – the motion of horseback riding carries a risk of placental abruption (separating the placenta from the uterus). Falling from or being kicked by a horse carries a high risk of trauma to your baby, or even death. High-altitude activities such as mountain climbing – at heights over 3,000 metres, the oxygen level in the air is low.

This reduces the oxygen available to your baby

Pregnant women are also more vulnerable to developing altitude sickness. Be careful to avoid food poisoning, as certain infections can harm the baby or trigger miscarriage. Remember to: Wash your hands thoroughly after going to the toilet, before preparing food and before eating.

In developing nations, only eat fruit that you have peeled yourself. Avoid leafy greens and salads because they could have been washed in contaminated water. Drink bottled water if you are unsure of the water supply.

Use bottled water when brushing your teeth

Make sure that all eating utensils are thoroughly dried after washing.

If you must use the local water, boil the water thoroughly for five minutes before using.

Avoid treating unsafe water with iodine

If consumed over a few weeks, iodine can cause your unborn baby to develop a goitre (enlarged thyroid gland). Pregnant women should be wary of taking medications of any kind. Some medications can pass to the baby through the placenta and cause birth defects or miscarriage.

Avoid taking any over-the-counter medication unless advised by your doctor, who knows you are pregnant. that are commonly used to treat traveller’s diarrhoea are dangerous during pregnancy.

Avoid alcohol

Avoid using ‘social’ or ‘recreational’ drugs. About pregnancy and travel High-risk pregnancies and travel cervical problems, such as ‘incompetent cervix’ vaginal bleeding multiple pregnancy gestational diabetes, past or present high blood pressure, past or present pre-eclampsia (a toxic condition sometimes occurring in pregnancy), past or present abnormalities of the placenta, past or present prior miscarriage prior ectopic pregnancy (a pregnancy that develops outside the womb) Travel immunisation warnings for pregnant women Travel and the risk of malaria during pregnancy Risks of long-distance travel during pregnancy you had a DVT in the past you weigh more than 100 kg you have a multiple pregnancy Air travel and pregnancy Check with the airline – oral rehydration preparations in case of traveller’s diarrhoea multivitamins formulated for pregnant women Car travel and pregnancy rhesus negative Heat and sun exposure and pregnancy Overheating during pregnancy to seek shade or go inside, drink a glass of cool water and lie down Sporting activities and pregnancy Traveller’s diarrhoea and pregnancy Avoid food buffets, seafood, undercooked meats, soft cheeses and p â t é Medications to avoid during pregnancy Medications Where to get help Your GP (doctor) NURSE-ON-CALL Tel. (616) 555-0024 – for expert health information and advice (24 hours, 7 days).

Key Points

• important exception to this is the influenza vaccine, which can be safely given during pregnancy
• pregnant woman who catches malaria risks miscarriage, premature labour and stillbirth
• risk of DVT is increased in pregnancy if: a family member has had a DVT
• Research indicates the risk of DVT can increase by two or three times in a long-distance flight
• If you have an increased risk of DVT, you are advised to: Discuss travel plans with your doctor