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 The
American College of Obstetricians and Gynecologists (ACOG) advises that
healthy women with uncomplicated pregnancies may travel observing the
same safety measures as the general population. The safest time for a
pregnant woman to travel is between 18 and 24 weeks, when the most
common obstetric problems are least likely to occur.
However, "travel is not recommended at any
time during pregnancy for women who have either medical or obstetric
complications for which likely emergencies cannot be predicted.
Such complications may include increased risks for, or evidence of,
preterm delivery, pregnancy induced hypertension, poorly controlled
diabetes, or sickle cell disease or trait, which may be exacerbated by
high altitude. " [1] In addition the CDC recommends that pregnant women
with serious underlying illnesses should not travel to developing
countries [2].
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TIPS FOR PREGNANT TRAVELERS
See your doctor before you plan to travel.
Before leaving home
locate the nearest hospital or medical clinic in the place you are
visiting in case of an emergency. Medical facilities should be able to
manage complications of pregnancy, toxemia, and cesarean sections.
Confirm that your health
insurance will provide coverage at your destination.
Ensure prenatal visits
requiring specific timing are not missed.
Consider buying travel
insurance for tickets and deposits that can't be refunded in case you need
to cancel your trip because of pregnancy complications.
Take a copy of your prenatal records with you.
Dimenhydrinate (Dramamine®) or meclizine
(Bonine®) are Category B drugs that may be used to prevent motion
sickness or decrease nausea.
If you are traveling by automobile
- Try to drive no more than 5 or 6 hours
each day
- Wear your seat belt.
-
Stop to stretch your legs every hour or so. Stretching
your legs will lessen the risk of blood clots.
If you are traveling by plane
-
Check with your airline about possible requirements regarding
documentation of gestational age.
- Some airlines require women traveling
in their ninth month of pregnancy to have an obstetrician’s certificate
dated within 72 hours prior to their flight departure stating the
estimated due date and that the woman is physically fit to travel by
air to a particular destination on a given date. Other airlines will
not carry women after 36 weeks' of pregnancy under any circumstances.
- Remember: All liquids, gels and aerosols must be in three-ounce or
smaller containers placed in a single, quart-size, zip-top, clear
plastic bag. Each container must be three ounces or smaller.
Insulin and heparin vials
or asthma inhalers are usually less than 3 ounces.
- If medically necessary items exceed 3 ounces or are not
contained in a one-quart, zip-top plastic bag, you MUST declare to one
of our Security Officers at the checkpoint for further inspection.
- Visit the
The
Transportation Security Administration for more information.
- Avoid foods that cause gas before a flight because
the entrapped gas will expand at high altitude
-
Stop to stretch your legs every hour or so.
Stretching your legs will lessen the risk of blood clots
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Potential Contraindications to International Travel
During Pregnancy
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Medical Risk
Factors |
Obstetrical Risk Factors |
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History of thromboembolic disease
History of thromboembolic disease
Pulmonary hypertension
Severe asthma or other chronic lung disease
Valvular heart disease (if NYHA class III or IV heart failure)
Cardiomyopathy
Hypertension
Diabetes
Renal insufficiency
Severe anemia or hemoglobinopathy
Chronic organ system dysfunction requiring frequent medical
interventions
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History of miscarriage
Incompetent cervix
History of ectopic pregnancy (ectopic with current pregnancy should
be ruled out before travel)
History of premature labor or premature rupture of membranes
History of or existing placental abnormalities
Threatened abortion or vaginal bleeding during current pregnancy
Multiple gestation in current pregnancy
Fetal growth abnormalities
History of toxemia, hypertension, or diabetes with any pregnancy
Primigravida at ≥35 years of age or ≤15 years of age
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From: CDC Health Information for International Travel 2008
[2]
Foreign Travel [2]
Before leaving home, locate the nearest hospital or
medical clinic in the place you are visiting. To find a doctor there, call the
International Association for Medical Assistance to Travelers at (716) 754-4883
or check with the American Red Cross (www.redcross.org or look in your phone
book for the number of your local chapter).
Pregnant women should avoid travel to
potentially hazardous destinations such as:
- Areas endemic for or with ongoing
outbreaks of life-threatening food- or insect borne infections
- Areas where chloroquine resistant
P. falciparum malaria is endemic
- Areas where live virus vaccines are required and recommend
If a pregnant woman must travel to areas with chloroquine-sensitive
Plasmodium falciparum malaria,
chloroquine has been used for malaria chemoprophylaxis for decades with no
documented increase in birth defects.
If a pregnant woman must travel to areas
with chloroquine-resistant P. falciparum,
mefloquine should be recommended for chemoprophylaxis during the second and
third trimesters (3). For women in their first trimester, most evidence
suggests that mefloquine prophylaxis causes no significant increase in
spontaneous abortions or congenital malformations if taken during this period
(3)
Health information for specific destinations may be from the CDC obtained at :
http://wwwn.cdc.gov/travel/destinationList.aspx
The only vaccine required by International Health Regulations is yellow fever vaccination for
travel to certain countries in sub-Saharan Africa and tropical South America.
Meningococcal vaccination is required by the government of Saudi Arabia for
annual travel during the Hajj.
Yellow Fever
Use the Health Information for International Travel information below
to determine if you will need a yellow fever certificate, and find a clinic
that can give the vaccination and issue the certificate.
For more information call the International Travelers Hotline at the Centers
for Disease Control and Prevention (CDC). This service has safety tips and
up-to-date vaccination facts for many countries. The number is (404)
332-4559.
CDC Health Information for International Travel 2008 (The Yellow Book) is published by the Centers for Disease
Control, and is made available to health care providers who advise
international travelers of health risks at:
http://wwwn.cdc.gov/travel/yellowBookCh9-PregnancyTraveling.aspx
REFERENCES
1.American College of Obstetricians and Gynecologists. ACOG Committee
Opinion No. 264. Air travel during pregnancy. Obstet Gynecol. 2001;98:1187-8.
2. Centers for Disease Control and Prevention. CDC Health Information for
International Travel 2008 . Planning for a Healthy Pregnancy and Traveling
While Pregnant http://wwwn.cdc.gov/travel/yellowBookCh9-PregnancyTraveling.aspx
(Accessed 12/3/07)
3.CDC. Preventing malaria in travelers.
http://www.cdc.gov/malaria/pdf/travelers.pdf. (Accessed 11/6/2007.)
Created: 12/3/2007 Mark A Curran, MD
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