Pregnancy

The pregnant traveller faces a variety of health hazards, and travelling during pregnancy, particularly to tropical areas in developing countries, should only be undertaken if it is truly necessary. Health hazards include the problems of air travel itself and increased exposure to infectious diseases.

General Advice

The safest time for pregnant women to travel is during the second trimester. Don’t travel during the last six weeks of your pregnancy. Hepatitis E is of special concern if travelling to developing countries.

Nausea and vomiting

The tendency to nausea and vomiting in early pregnancy may be aggravated by travel.

In general drugs given for motion sickness should he avoided during the first trimester. Consult your obstetrician about any medication you plan to use. Carry your medications with you rather than packing them in your check-on luggage.

Activities

Exercising within the limits of your fitness and comfort is generally a good idea.

Vigorous exercise like running may cause hyperthermia (high body temperature). This can be dangerous to the developing baby. Saunas and very hot tubs should also be avoided in the first 3 months of pregnancy for this reason.

Swimming is an excellent exercise for the pregnant traveller, but water-skiing and other activities with an increased risk of injury are best avoided.

Scuba diving to depths greater than 18m (60 ft) is not considered safe. Vacationing at high altitudes, particularly greater than 3000m, is best avoided.

Air Travel

Up to 24 weeks gestation: No restrictions unless complicating obstetric or medical risk factors exist.

24-36 weeks gestation: No restrictions unless complicating obstetric or medical risk factors exist.

The pregnant traveller should carry a letter from her obstetrician.

After 36 weeks gestation: Air travel is discouraged unless unavoidable. If travel is essential, a doctor’s letter is required by all airlines.

General Information

Most commercial jetliners are pressurised to about 1600 to 2300m. Above 1600m there is a risk of hypoxia (low oxygen), especially if the traveller is anaemic.

It is advisable to sit in the non-smoking area, and wear your seat belt low around your pelvis.

Carbonated drinks are best avoided as they may cause gaseous distension which can be uncomfortable.

A particular problem of long haul air travel is deep vein thrombosis (blood clot in the legs). Sitting in a cramped position for a long period favours the development of thrombosis. Take an aisle seat and stand up and walk about the cabin regularly. Tense up your legs and wriggle your toes from time to time.

Dehydration also predisposes to thrombosis, and the low humidity in aircraft predisposes to dehydration. DRINK plenty of fluids not containing alcohol (or caffeine).

Vaccinations

It is preferable to avoid vaccinations, if possible, in the first 3 months of pregnancy and to avoid live viral vaccines, particularly rubella, measles, and mumps (MMR) throughout pregnancy.

Avoid vaccines which may be associated with a febrile reaction (fever) in the first 3 months of pregnancy.

Safe Vaccines: (after the 1st 3 months) – Immune (gamma) globulin, ADT, Hep A, Hep B, Typhium Vi, Meningococcal and Rabies. Influenza may be a serious infection in pregnancy and influenza vaccine is indicated.

Unsure Vaccines: Yellow Fever, BCG, oral typhoid, polio and JE vaccine should only be given if substantial risk of infection.

Traveller’s Diarrhoea: Do not eat uncooked meat as it may cause toxoplasmosis, an infection that could affect the foetus.

Avoid dehydration in pregnancy. Severe dehydration increases the risk of miscarriage. Carry rehydration sachets.

Avoid soft, ripened cheeses and smoked salmon which may carry the bacteria Listeria, which can also cause miscarriages.

Drugs such as diphenoxylate (Lomotil) and loperamide (Imodium or Gastro Stop) should be avoided.

Malaria

Avoid Travelling to Malarious areas unless absolutely essential. If you must travel to areas that are Malarious:

Doxycycline is contraindicated during pregnancy and Mefloquine is not approved for the first 3 months of pregnancy although recent reports suggest that it is probably safe. Chloroquine with or without Proguanil and meticulous avoidance of mosquito bites is safe in pregnancy. Malarone (Atovaquine + proguanil) is class B2 & azithromycin B1, and their use cannot be recommended as yet because of very little data.

If emergency self-treatment for malaria is required for a pregnant woman, quinine is preferred.

Other infections

A wide range of conditions are more severe in pregnancy. Many infections adversely affect the baby as well as the mother. Pregnant travellers should therefore take particular care to avoid biting insects and to disinfect minor cuts and abrasions. The use of Iodine as a water steriliser is best avoided as this can affect the baby’s thyroid gland.

Pregnant women, already prone to thrush, should be aware of the increased risk in the tropics.

Hepatitis E

Hepatitis E, formerly called non-A, non-B hepatitis is particularly serious in the 2nd & 3rd trimesters of pregnancy. Epidemics have occurred in Afghanistan, Bangladesh, western China, Eritrea, Ethiopia, India, Indonesia, Iran, Kenya, Mexico, Myanmar, Nepal, Pakistan, Somalia, Sudan, and the Asian republics of the former USSR. It is probably widespread in Asia, north and sub-Sahara Africa, and the eastern Mediterranean area.

There is no treatment available and 15-20% of women will die from fulminant hepatitis*. As it is spread in the same way as Hepatitis A (ie. by contaminated food or drink) the need to eat and drink safely and observe good hygiene is paramount. Again reconsider the need to travel whilst pregnant.

Information extracted from: – Fairfield Hospital Travel information pamphlet: Pregnancy 1994 * International Travel and Health – World Health Organisation 1999 year book p64 & p88. Information mostly taken from: “International Travel and Health” (WHO year book 2004)

Travel Health Seminar March 2003. Vic Med Postgraduate Foundation. Updated March 2004. Further references & disclaimer.