Please note – the views in the following feature are those of the author and are not necessarily endorsed by Safe Travels Magazine. Before travel, we recommend that you always do your own research, read travel advisories and buy appropriate travel insurance.

Claudia Zegans, MD, Associate Medical Director at Global Rescue

Email: press@globalrescue.com
Website: https://www.globalrescue.com/
Twitter: https://twitter.com/GlobalRescue
LinkedIn: https://www.linkedin.com/company/global-rescue-llc

Global Rescue is the world’s leading provider of integrated health, safety and travel risk management services. Since 2004, the firm has pioneered the delivery of medical, rescue and evacuation services to some of the earth’s most difficult places.


Travel during pregnancy

For most women, traveling during pregnancy is safe. As long as you and your fetus are healthy, most women can travel safely until 36 weeks gestation. Travel is not recommended if you have certain pregnancy complications, including preeclampsiapremature rupture of membranes, and preterm labor. Travel also may not be a good idea if you are pregnant with more than one fetus.  The decision to travel when pregnant must be an individual one, and made in conjunction with a woman’s obstetric provider and a travel health medical consultant.  It is important to consider a variety of factors when making this decision, including the status of the pregnancy, increased health risks in certain destinations for pregnant women, and the potential for complications and/or side effects from preventive measures such as vaccines and medications.

Zika virus

For example, pregnant women should not travel to areas with risk of acquiring Zika virus infection (i.e., with documented or likely Zika virus transmission). Zika virus infection during pregnancy can cause severe birth defects.  If you must travel to one of these areas, talk to your doctor or other health care provider first and strictly follow the recommended steps to prevent mosquito bites and practice safe sex. Partners of pregnant women and couples considering pregnancy should also know the risks to pregnancy and take preventive steps. Sexual transmission of Zika virus is possible for up to several months after leaving a Zika transmission area; it is essential to consult with a health care provider for specific guidance on preventive practices in individual situations.  It is prudent for all travelers to strictly follow steps to prevent mosquito bites and prevent sexual transmission during and after the trip.

Africa: AngolaBeninBurkina-FasoBurundiCameroonCape VerdeCentral African RepublicChadCongo (Congo-Brazzaville)Côte d’IvoireDemocratic Republic of the Congo (Congo-Kinshasa)Equatorial GuineaGabonGambiaGhanaGuineaGuinea-BissauKenyaLiberiaMaliNigerNigeriaRwandaSenegalSierra LeoneSouth SudanSudanTanzaniaTogoUganda

Asia: BangladeshBurma (Myanmar)CambodiaIndiaIndonesiaLaosMalaysiaMaldivesPakistanPhilippinesSingaporeThailandTimor-Leste (East Timor)Vietnam

The Caribbean: AnguillaAntigua and BarbudaArubaBarbadosBonaireBritish Virgin IslandsCubaCuraçaoDominicaDominican RepublicGrenadaHaitiJamaicaMontserratthe Commonwealth of Puerto Rico, a US territorySaba; Saint Kitts and NevisSaint LuciaSaint MartinSaint Vincent and the GrenadinesSint EustatiusSint MaartenTrinidad and TobagoTurks and Caicos IslandsUS Virgin Islands

Central AmericaBelizeCosta RicaEl SalvadorGuatemalaHondurasNicaraguaPanama

North America: Mexico

The Pacific Islands: FijiPapua New GuineaSamoaSolomon IslandsTonga

South America: ArgentinaBoliviaBrazilColombiaEcuadorFrench GuianaGuyanaParaguayPeruSurinameVenezuela[1]

Malaria

Malaria may be much more serious in pregnant than in nonpregnant women and is associated with high risks of illness and death for both mother and child, and travel to areas where malaria is endemic is not recommended during pregnancy.  Because no prophylactic regimen provides complete protection, pregnant women should avoid or delay travel to malaria-endemic areas. However, if travel is unavoidable, pregnant women should take precautions to avoid mosquito bites, and use of an effective prophylactic regimen is essential. [2]  Consult with your travel health professional for specific medication recommendations.  Insect repellents that contain DEET and Picardin are considered safe in pregnancy; concentrations between 20 – 35% are recommended.

World Map of Areas with Malaria

A pregnant woman should seek a pretravel medical evaluation before traveling. The pretravel evaluation of a pregnant traveler should begin with a careful medical and obstetric history, with particular attention to gestational age and evaluation for high-risk conditions. A visit with an obstetrician should be a part of the pretravel assessment, to ensure routine prenatal care as well as identify any potential problems. The traveler should be provided with a copy of her prenatal records and physician’s contact information. Checking for immunity to various infectious diseases may obviate the need for some vaccines. [3] Plan to bring any over-the-counter medications that you may need, such as pain relievers, hemorrhoid ointment, a first aid kit, and prenatal vitamins. Also bring any prescribed medications. Make travel plans easy to change and consider buying travel insurance to cover tickets and deposits that cannot be refunded.

How safe is it to travel while pregnant?

As long as there are no identified complications or concerns with your pregnancy, it is generally safe to travel at all times during pregnancy.  Most sources recommend avoiding travel after 36 weeks gestation, and airlines can enforce this limit.  However, it is an ideal time to travel during the 2nd trimester, when pregnancy-related emergencies occur less frequently.

There are some clear reasons not to travel when pregnant.  Certain pregnancy complications such as premature labor, premature rupture of membranes, and preeclampsia are absolute contraindications to travel; others can place the mother or baby at increased risk and are relative contraindications to travel, such as placenta previa, incompetent cervix, and multiple gestation.  If a woman has a history of miscarriage, it might be prudent to delay or avoid travel.

Pregnant women and their loved ones must understand that no one can guarantee that no harm will occur to her baby during the trip, whether related to travel or not.  If the pregnant traveler is highly risk averse, or if she feels that she might blame any adverse events that happen on her decision to travel, she should consider postponing travel during pregnancy.

Frequently Asked (Pregnant Travel) Questions

Some answers to common questions about travel during pregnancy.

Radiation exposure during airplane flight?

“Radiation” is a terrifying word to expectant mothers, yet plane travel is generally safe in this regard.

Whether on land or in the air, we are exposed every day to cosmic ionizing radiation, which emanates from the sun and other stars. On the ground, the Earth’s atmosphere offers some protection from the radiation. At high altitudes, the air is thinner and radiation levels are somewhat higher, but they’re not usually high enough to be of concern to the occasional traveler.

The exposure to radiation during a commercial flight is very low and is below the dose that could potentially harm the embryo or fetus at all stages of gestation. Therefore, when you fly, stage of gestation is irrelevant from a radiation standpoint.

Is it safe to walk through airport screening machines while I’m pregnant?

Yes. Airport detectors may use a magnetic field, extremely low-energy radio waves, or minute doses of X-rays to screen passengers for unsafe objects. The amount of energy associated with each of these exposures is much too low to be harmful to you or your developing baby.

Backscatter scanners use very low-dose X-rays. A dose of radiation can be expressed in microsieverts. It takes about 500,000 microsieverts to harm a developing baby. Backscatter units result in radiation exposure of fewer than 1 microsieverts, which is far too low to cause damage to you or your child.

Are there areas to avoid traveling while pregnant?

It is generally recommended that travel be avoided for pregnant women in areas where Zika, malaria or other mosquito-borne illnesses are endemic (see Zika virus information above). When traveling to such locations, pregnant women should take extra efforts to prevent any mosquito bites.

Travel to high altitude regions can also potentially lead to challenging situations.  Short-term exposure to altitudes up to 2,500 meters in women with uncomplicated pregnancies appears to pose minimal risk, but it is prudent to avoid sleeping altitudes above 3,660 m, partly due to the remote nature of higher altitudes that precludes access to medical care.  This is also true of general travel to remote areas.

Highly risk averse pregnant travelers should avoid traveling to areas where medical care may not meet the standards of their home providers, and they will not be comfortable or accepting of the medical care available to them.

What are the biggest risks for travel while pregnant?

A significant risk during pregnancy travel is Deep Vein Thrombosis, DVT.  A DVT is a blood clot that forms in deep veins, most commonly in the legs, causing pain, inflammation, and swelling.  A DVT can partially break off and travel to other parts of the body (lung, brain) causing even more serious conditions, such as pulmonary embolism.  To avoid this, pregnant travelers must ensure they are well mobilized, may wear “compression stockings” and ensure good hydration.

Traveling may also expose any individual and especially pregnant women to the risk of consuming contaminated food and water.  Traveler’s diarrhea can be a serious illness even in non-pregnant travelers, but the risk of dehydration and other complications is higher for pregnant women and their fetuses. Routine medications used to treat traveler’s diarrhea may be harmful to the developing fetus.  Also, certain infections, such as Hepatitis A and listeriosis, are acquired through contaminated food and water; these diseases can cause severe complications for a pregnant woman and her fetus.

What are the overlooked risks during pregnancy travel?

A woman’s body undergoes significant changes during pregnancy, increasing the potential for falls and other accidents.  This same issue would be present in her home environment, but the activity requirements of certain travel may put her and her fetus at risk.  Accidents are one of the most common causes of morbidity during travel, particularly motor vehicle accidents.  Pregnant women need to be diligent about seat belt use and other safety precautions when moving about during travel to avoid injury.

The quality of healthcare available during travel is also often overlooked. There are remote locations with scarce medical resources which may pose some risk when an expectant mother experiences a complication: what might be a routine issue at home may be a larger concern if only insufficient or substandard medical care is available.

It is also more of a challenge for a pregnant traveler to protect herself from some of the risks of travel.  Some of the immunizations and medications available for prevention and/or treatment  may be harmful to the developing fetus or to the mother.   Examples include some of the live virus vaccines, Diamox for altitude sickness, and antimalarials such as malarone and doxycycline.

How should pregnant women mitigate the risk during travel?

As mentioned above, it is highly recommended for pregnant women to have a travel health consultation prior to travel; ideally this consultation should occur 3-4 months before the trip to allow adequate time to complete needed vaccinations.  Although some medications and vaccines are not recommended during pregnancy, there are alternatives that are safe, and other preventive or treatment measures that can be emphasized to replace those that are less safe.  Follow the advice given to you by your travel health provider.

Be prepared with information about safe air travel when pregnant.

  1. Contact the air providers to know their rules and regulations for traveling pregnant. Bring all necessary medical documents pertaining to pregnancy during travel.
  2. As much as possible, avoid long leg flights. Multiple leg flights could be tiring but can also reduce the risk of DVT.
  3. Additional measures to avoid DVT include wearing compression stockings, doing leg exercises during flight, and good hydration.
  4. Plan your meals before the flight to avoid any problem inflight relating to food consumption.

Be prepared with information on medical care available at the destination, and other itinerary points during travel.  Have the names of specific preferred hospitals and physicians that speak your language.  Arrange to have access to your medical records while traveling in the event of need to seek medical attention.

Pregnant travelers should carry a medical kit with items that address pregnancy issues, including prenatal vitamins, an antiemetic, acetaminophen, hemorrhoid cream, medication for yeast vaginitis, and compression stockings, as well as any other prescribed medications and/or travel medications.  It is also prudent to consider a blood pressure monitor and dipsticks for use during the third trimester.

Know what “food and water precautions” really means, and follow these recommendations strictly. Understand and engage in effective insect precautions.

As for any travel, access to adequate health insurance as well as evacuation coverage is essential to allow timely presentation to the appropriate level of care.  A Medical Advisory service, such as that provided by Global Rescue, is also important to allow for real-time advice on self-care, as well as referral to appropriate medical care.  Being responsible for both yourself and your baby makes these elements of travel safety even more important.

References


Footnotes

[1] https://wwwnc.cdc.gov/travel/page/world-map-areas-with-zika

[2] https://wwwnc.cdc.gov/travel/yellowbook/2018/advising-travelers-with-specific-needs/pregnant-travelers

[3] https://wwwnc.cdc.gov/travel/yellowbook/2018/advising-travelers-with-specific-needs/pregnant-travelers

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