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 Travel During Pregnancy

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].

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 medications 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.
    • 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.
    • The American College of Chest Physicians (ACCP) recommends  that travelers who are taking flights greater than 8 hours avoid constrictive clothing around the lower extremities or waist, stay well hydrated (drink plenty of fluids), and  frequent calf muscle contraction (walk about).
      • The ACCP recommends the use of graduated compression stockings (GCS)  or a single prophylactic dose of low molecular weight heparin prior to departure if you are a long distance traveler and your physician believes you to be at high risk for blood clots and is considering additional measures  to prevent the formation of blood clots,
      • The ACCP recommends against the use of aspirin for venous thromboembolism (VTE) prevention [4].

           Airport Security

    • Hand-held metal detectors and walk through metal detectors do not appear to pose a hazard to for pregnant women and their fetuses [5,6].
    • Backscatter units create an image from very small amounts of x-ray that reflect off the person being screened.   According to Rapiscan, the manufacturer of the backscatter units, the  dose for one screening from a backscatter unit is 5 microrems (5 millionths of a rem) [7] which is about 1/2000th (0.05% ) the radiation dose received from one chest x ray , a negligible risk according to the International Commission on Radiological Protection [8]. Travelers may refuse a body scan and opt for a pat-down instead.
    • 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.

  • Potential Contraindications to International Travel During Pregnancy
     
    Medical Risk Factors Obstetrical Risk Factors
  • 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
  • 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
     
  • 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://wwwnc.cdc.gov/travel/destinations/list.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 Centers for Disease Control and Prevention (CDC). This service has safety tips and up-to-date vaccination facts for many countries. The number is (800) 232-4636. 

    CDC Health Information for International Travel 2012 (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://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-8-advising-travelers-with-specific-needs/pregnant-travelers.htm

     

    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 2012 Yellow Book . Traveling While Pregnant http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-8-advising-travelers-with-specific-needs/pregnant-travelers.htm
    (Accessed 5/31/12)
    3.CDC. Preventing malaria in travelers. http://www.cdc.gov/malaria/pdf/travelers.pdf. (Accessed 6/5/2010.)
    4.
    Geerts WH, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).Chest. 2008 Jun;133(6 Suppl):381S-453S.PMID:18574271
    5 Kainz W, et al. Calculation of induced current densities and specific absorption rates (SAR) for pregnant women exposed to hand-held metal detectors. Phys Med Biol. 2003 Aug 7;48(15):2551-60.PMID:12953914
    6. Wu D, et al. Possible overexposure of pregnant women to emissions from a walk through metal detector. Phys Med Biol. 2007 Oct 7;52(19):5735-48. Epub 2007 Sep 10. PMID: 17881797
    7. Transportation Security Administration’s Use of Backscatter Units, The Department of Homeland Security, Office of Inspector General, February 14, 2012 OIG-12-38 http://www.oig.dhs.gov/assets/Mgmt/2012/OIG_12-38_Feb12.pdf

    8. Kal HB, Struikmans H. Pregnancy and medical irradiation; summary and conclusions from the International Commission on Radiological Protection, Publication 84 Ned Tijdschr Geneeskd. 2002 Feb 16;146(7):299-303

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