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Travel And Pregnancy

You've been making plans to take that "trip of a life-time!" But, now you find out you're pregnant. What should you do? Should you still take that trip?

As always, talk with your doctor about your individual situation, but here are some tips from the US Centers for Disease Control and Prevention (CDC) that may help you decide.

Factors affecting the decision to travel

Although pregnancy is a normal state rather than a disabled condition, pregnant women need to consider the potential problems associated with international travel, as well as the quality of medical care available at the destination and during transit.

According to the American College of Obstetricians and Gynecologists, the safest time for a pregnant woman to travel is during the second trimester (18-24 weeks) when she usually feels best and is in least danger of experiencing a spontaneous abortion or premature labor.

Women in the third trimester (25-36 weeks) may be asked by their physicians to stay within 300 miles of home because of concerns about access to medical care in case of problems such as hypertension, phlebitis, or false or premature labor. The final decision to travel should be based on consultation with the woman's health care provider.

General recommendations for travel

Once a pregnant woman has decided to travel, a number of issues need clarification prior to departure. It is advisable for pregnant women to travel with a companion; in addition, attention to comfort becomes more important. The checklist below provides a guideline for planning with regard to medical considerations.

• Make sure health insurance is valid while abroad and during pregnancy. Check to see if the policy covers a newborn should delivery take place. Obtain a supplemental travel insurance policy and a prepaid medical evacuation insurance policy.
• Check medical facilities at the destination. For women in the last trimester, medical facilities should be able to manage complications of pregnancy, toxemia, and cesarean sections.
• Determine beforehand whether prenatal care will be required abroad and, if so, who will provide it. Make sure prenatal visits requiring specific timing are not missed.
• Check ahead of time whether blood is screened for HIV and hepatitis B at the destination. Pregnant travelers and their companions should know their blood types.
• Check facilities at the destination for availability of safe food and beverages, including bottled water and pasteurized milk

Motor vehicle accidents are a major cause of morbidity and mortality. When available, seat belts should be fastened at the pelvic area. Lap and shoulder restraints are best; in most accidents, the fetus recovers quickly from the seat belt pressure. However, even after seemingly blunt, mild trauma, a physician should be consulted.

Typical problems of pregnant travelers are the same as those experienced at home: fatigue, heartburn, indigestion, constipation, vaginal discharge, leg cramps, increased frequency of urination, and hemorrhoids. Signs and symptoms that indicate the need for immediate medical attention are bleeding, passing tissue or clots, abdominal pain or cramps, contractions, ruptured membranes, excessive leg swelling, headaches, or visual problems.

Immunizations

Because of the theoretical risks to the fetus from maternal vaccination, the risks and benefits of each immunization should be carefully reviewed. Ideally, all women who are pregnant should be up to date on their routine immunizations.

In general, pregnant women should avoid live vaccines and women should avoid becoming pregnant within 3 months of having received one; however, no harm to the fetus has been reported from the accidental administration of these vaccines during pregnancy.

Talk with your doctor about your specific immunization needs, including any additional immunizations you may need depending on the countries you may be visiting.

Traveler's diarrhea during pregnancy

Dietary vigilance should be adhered to while traveling during pregnancy because dehydration due to traveler's diarrhea (TD) can lead to inadequate placental blood flow.

Potentially contaminated water should be boiled. Iodine-containing purification systems should not be used long term. Iodine tablets can probably be used for short-term travel up to several weeks, but congenital goiters have been reported in association with administration of iodine-containing drugs during pregnancy.

Eating only well-cooked meats and pasteurized dairy products, as well as avoiding pre-prepared salads, should help avoid diarrheal disease, as well as infections such as toxoplasmosis and listeria, which can have serious sequelae in pregnancy. It is not recommended that pregnant women use prophylactic antibiotics for the prevention of TD.

Oral rehydration is the mainstay of therapy. Bismuth subsalicylate compounds are contraindicated due to the theoretical risks of fetal bleeding from salicylates and teratogenicity from the bismuth. The combination of kaolin-pectin may be used, and loperamide should be used only when necessary. The antibiotic treatment of TD during pregnancy can be complicated. An oral third-generation cephalosporin may be the best option for treatment if an antibiotic is needed.

Air travel during pregnancy

Commercial air travel poses no special risks to a healthy pregnant woman or her fetus. The lowered cabin pressures (kept at the equivalent of 5,000-8,000 feet or 1,524-2,438 meters) affect fetal oxygenation minimally because of the fetal hemoglobin dissociation curve.

Severe anemia (Hgb 0.5 g/dL), sickle-cell disease or trait, and a history of thrombophlebitis or placental problems are relative contraindications to flying; however, supplemental oxygen may be ordered in advance.

Each airline has policies regarding pregnancy and flying; it is always safest to check with the airline when booking reservations, as some will require medical forms to be completed. Domestic travel is usually permitted until 36 weeks gestation, and international travel may be curtailed after the 32nd week. Pregnant women should always carry documentation stating their expected date of delivery.

An aisle seat at the bulkhead will provide the most space and comfort, but a seat over the wing in the midplane region will give the smoothest ride. A pregnant woman should walk every half hour during a smooth flight and flex and extend the ankles frequently to prevent phlebitis. The seat belt should always be fastened at the pelvic level. Fluids should be taken liberally because of the dehydrating effect of the low humidity in aircraft cabins.

The travel health kit during pregnancy

Additions and substitutions to the usual travel health kit need to be made during pregnancy. Talcum powder, a thermometer, oral rehydration packets, multivitamins, an antifungal agent for vaginal yeast infection, acetaminophen, insect repellent containing a low percentage of DEET, and sunscreen with a high SPF (sun protection factor) should be carried.

Women in their third trimester may want to carry a blood pressure cuff and urine dipsticks to check for proteinuria and glucosuria, both of which would require attention. Antimalarial and antidiarrheal self-treatment medications should be evaluated individually, depending on the traveler, her trimester, the itinerary, and her health history. Most medications should be avoided, if possible.

Your PersonalMD.com Personal Medical Record is a valuable aid when traveling, and during your pregnancy. Using your ER Card, your medical information can be made available to emergency physicians anywhere in the world. If you haven't signed up for this service, you can do so now, by clicking here.

For more information on travel, go to our Travel Center. For more information on Pregnancy, go to Women's Health.

Source: Centers for Disease Control and Prevention

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