Dr Simon Worrell, Deputy Chief Medical Officer and Head of Medical Communications at Healix International
Dr Simon Worrell is the Deputy Chief Medical Officer and Head of Medical Communications at Healix International. Healix is a leading provider of global travel risk management and international medical, security and travel assistance services.
How safe is it to travel while pregnant?
Travelling is certainly possible when pregnant but some thought needs to occur about the timing and the location of the travel.
The timing of travel is usually informed by two issues occurring at either end of the gestation: as many of the risks to the developing baby occur early on in pregnancy, and obviously travel in the later period of pregnancy is physically demanding for mum, travelling during the 4-6 month of pregnancy is seen as the most sensible. Although this is the best time to travel, for those who go into labour early and deliver a preterm baby, it is crucial to ensure that the location abroad has good neonatal health services able to care for babies as young as 24 weeks. In practice this means that travel should be restricted to cities that have a western standard of healthcare. Should such a preterm delivery occur, the baby and parents will likely stay abroad until the child is 40 weeks old, meaning a stay of several months. As an air ambulance (a bespoke jet and medical team) will usually be required to get the family home, getting good travel insurance to cover such an eventuality is clearly of great importance.
Airlines do have guidelines as to how advanced a pregnancy can be to be allowed to travel: if you have a single pregnancy, you cannot travel after the 36th week; if more than one foetus, no later than 32 weeks. For those intending to fly near the 36th week, it’s a good idea to take a note from your midwife or doctor stating the estimated date of delivery, the number of foetuses, and that there have been no complications. The check-in staff at the airports may well decline your boarding the airplane if they think you seem later on in your pregnancy. During the flight itself, it is recommended that pregnant mums wear loose fitting, comfortable clothes and move about the cabin regularly. This is because feet can become more swollen than usual during the flight and DVTs are much more common during pregnancy. Keeping well hydrated and resisting the repeated offers of free booze, is also a good idea.
What are the biggest risks?
The risks to the developing baby from infection should be clearly considered. For most travellers, temporary digestive upsets from ‘traveller’s diarrhoea’ is a common occurrence: upsetting both the traveller and their plans, but of little long-term significance. For those who are pregnant, often in a hot climate abroad, traveller’s diarrhoea can represent particular risks to both the mother and the child. Profound dehydration can result requiring hospitalisation if unable to replace the fluid loss with adequate amounts of oral fluids. For this reason, practicing food and water safety whilst away is essential to avoid stomach infections. Drink only bottled water and eat food from trustworthy restaurants, shunning tempting street food.
Some countries have specific infectious risks, however. The most feared risk at present comes from the Zika virus, spread by mosquitos in tropical areas. As has received wide global attention, Zika when caught during pregnancy can sometimes produce devastating abnormalities to the developing brain of the baby. For those who are pregnant considering travel to a country with active Zika transmission, it is recommended that the trip is postponed until after delivery. Although the risk of developing such foetal abnormalities is probably small, as the consequences are so great should it occur, most respected authorities advise mums not to take the risk, and go elsewhere in the world.
An infection that is often overlooked is malaria, common in many countries around the globe. Most travellers to malarious areas are able to take antimalarial medication, which reduces the risk of getting infected. For those who are pregnant, however, there are restrictions on the antimalarial tablets that can be safely taken; some causing proven side-effects in developing babies and others not being sufficiently tested in pregnancy at all. As pregnant women can develop particularly severe malaria, threatening the life of both mum and the baby, it is again advised that travel to these countries is reserved for another time.
What are the overlooked risks?
Travellers generally know that they should get appropriate vaccinations before travelling, but not that there are some important immunisations that those pregnant should not receive.
One of these is the MMR vaccine. As there are regular, large outbreaks of measles in different parts of the world (including Europe at present), mums are particularly urged to ensure that they have received the MMR before travelling (and before getting pregnant). As we know, many people in the West have never received the MMR following unfounded scaremongering concerning its safety. The MMR is a live vaccine, however, meaning that in those with compromised immune systems, a viral infection can sometimes result. As the immune system is dampened during pregnancy to allow the development of the growing baby, live vaccines may present a risk to the foetus and so the MMR cannot be given until after delivery. Thus if an unimmunised pregnant woman travels to Europe, she and her baby will be at risk of measles. Women must get vaccinated with MMR before falling pregnant.
Another vaccine that falls into this category is the Yellow Fever vaccine, required for entry into some countries.
How should people mitigate this?
Early consultation with a travel medicine health professional, or your GP, is the key to being prepared for travel when pregnant. For those who have had preterm deliveries or other complications during previous pregnancies, travelling should be discussed with their obstetrician or midwife. And finally, arranging good travel and health insurance is clearly essential.
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