Pregnancy and travel

If you are pregnant, the safest time to travel is generally during the second trimester, as long as you are not experiencing any complications.

Before you go#

If you are pregnant and thinking about travel, talk to your doctor first, especially if your pregnancy is high risk. Consider the standard of medical care at your destination in case you need help. Check what your travel insurance covers, and whether your destination has any healthcare arrangement with your home country.

Travel to developing regions is not encouraged during pregnancy for several reasons, including the risk of disease and the more limited standard of medical facilities. Pregnant women experiencing complications are advised not to travel.

Complications that may make travel inadvisable include:

• cervical problems, such as an incompetent cervix
• vaginal bleeding
• multiple pregnancy
• gestational diabetes, past or present
• high blood pressure, past or present
• pre-eclampsia, past or present
• abnormalities of the placenta, past or present
• a previous premature labor
• a previous miscarriage
• a previous ectopic pregnancy (a pregnancy that develops outside the womb)

If you are aged 35 or over and pregnant for the first time, you are also advised to take extra care with travel plans.

Immunization warnings#

Travelers to many developing regions need to be immunized against diseases such as typhoid. Most vaccines are either unsafe for unborn babies or have not been adequately tested for safety in pregnancy.

An important exception is the influenza vaccine, which can be safely given during pregnancy. It is strongly recommended for all pregnant women, as influenza in pregnancy can be a very serious illness.

Generally, all live virus vaccines (such as mumps and measles) should be avoided during pregnancy. Some vaccines, such as for yellow fever, may be given cautiously after the first trimester. Be guided by your doctor. Because of these limits, it is often recommended that pregnant women delay travel to developing regions until after their baby is born.

Malaria#

Malaria is an infection carried by particular species of mosquito. A pregnant woman who catches malaria risks miscarriage, premature labor and stillbirth.

Some antimalarial drugs (such as chloroquine) are considered safe during pregnancy, but others (such as doxycycline) are potentially harmful to the unborn baby. It is recommended that pregnant women avoid traveling to areas where malaria is present.

Long-distance travel and deep vein thrombosis#

Sitting still for long periods during car, bus, rail and air travel increases the risk of clots forming in the deep veins of the leg, known as deep vein thrombosis (DVT). These clots can travel and lodge in other parts of the body, such as the lungs.

About one in 1,000 pregnant women will develop DVT, and research suggests the risk can increase by two or three times on a long-distance flight. The risk is higher if:

• a family member has had a DVT
• you have had a DVT in the past
• you weigh more than 100 kg
• you have a multiple pregnancy

If you choose to travel long distances, you should:

• do frequent leg exercises
• walk regularly (on a smooth flight, walk around the cabin)
• avoid dehydration by drinking plenty of water
• minimize alcohol and caffeine

If you have an increased risk of DVT, you are advised to:

• discuss your travel plans with your doctor
• wear well-fitting elastic below-knee compression stockings during the journey
• receive heparin injections before and after any journey longer than four hours, if your doctor advises

Air travel#

Before you decide to fly, discuss any risks particular to your pregnancy with your doctor. For example, a woman with gestational diabetes or a multiple pregnancy is generally advised not to fly. Be aware that air travel in the last six weeks of pregnancy could trigger premature labor.

Other practical steps:

• check the fine print of your travel insurance, as some policies may not cover pregnancy
• ask the airline for a bulkhead seat or a seat near an exit for extra leg room
• consider an aisle seat, which makes getting to the toilet easier
• discuss with your doctor whether you need to travel with a medical kit, and pack it in your carry-on luggage

A medical kit could contain:

• preparations for common pregnancy complaints such as heartburn, thrush, constipation and hemorrhoids
• oral rehydration preparations in case of traveler’s diarrhea
• multivitamins formulated for pregnancy
• urine dipsticks to check glucose levels, if required

During the flight:

• wear your seatbelt under your bump and across your lap
• stretch and move your legs regularly while seated
• consider wearing support stockings for the duration of the flight
• drink plenty of water to reduce dehydration and the risk of DVT
• if the flight is smooth, walk up and down the aisle every half hour; if there is turbulence, stay seated but flex and extend your ankles frequently
• if you feel short of breath or light-headed, ask a flight attendant for oxygen

A pregnant woman’s circulation is already under strain, and the lower cabin pressure in a plane can in theory increase the risk of blood clots, which is why these steps matter.

Car travel#

If traveling by car:

• take frequent breaks to stretch your legs and visit the toilet
• always wear a seatbelt: fasten the lap sash across your lap and under your bump, and fit the shoulder sash above your bump and between your breasts
• avoid wearing the lap sash across your bump, as a sudden jolt could cause the placenta to separate from the uterus
• if you are in the front passenger seat, move your seat well back from the dashboard to reduce airbag impact in a collision
• if you are driving, move your seat as far back from the wheel as you can while still driving safely and comfortably; tilting the wheel downwards, away from your belly, may help

If you are in a collision, however minor, see your doctor. If you have contractions, pain or bleeding afterwards, see a doctor as soon as possible. Let them know if you have a rhesus negative blood group, as you may need an anti-D injection. Consider joining a roadside assistance program, and always carry a mobile phone.

Heat and sun#

If traveling in hot weather:

• carry a water bottle and drink frequently
• stay in the shade or indoors during the hottest part of the day
• protect your skin with loose-fitting clothing, a hat and sunscreen
• avoid rushing or overexertion; plan your activities and allow plenty of time

Feeling weak, dizzy, light-headed or slightly nauseous can be a sign you are overheating and dehydrated. If this happens, seek shade or go inside, drink a glass of cool water and lie down. You can bring your temperature down with a fan, a cool wet cloth on your forehead and the back of your neck, or cool water over your wrists.

Sporting activities#

Certain activities carry an increased risk to your unborn baby. Activities to avoid include:

• water-skiing, as coming off the skis could force water into the vagina
• scuba diving, as changes in blood gases may harm your baby (snorkelling is fine, and diving to less than 18 meters (60 feet) is reasonably safe, but check with your doctor first)
• saunas and hot tubs, as raising your body temperature can harm your baby
• horseback riding, which carries a risk of placental abruption, and a high risk of trauma if you fall or are kicked
• high-altitude activities such as mountain climbing: above 3,000 meters the oxygen level in the air is low, reducing the oxygen available to your baby, and pregnant women are also more prone to altitude sickness

Traveler’s diarrhea and food safety#

Be careful to avoid food poisoning, as certain infections can harm the baby or trigger miscarriage. Remember to:

• wash your hands thoroughly after using the toilet, before preparing food and before eating
• in developing regions, only eat fruit you have peeled yourself
• avoid leafy greens and salads, which may have been washed in contaminated water
• avoid food buffets, seafood, undercooked meats, soft cheeses and pâté
• drink bottled water if you are unsure of the supply, including when brushing your teeth
• make sure all eating utensils are thoroughly dried after washing
• if you must use the local water, boil it thoroughly for five minutes first

Avoid treating unsafe water with iodine. If consumed over a few weeks, iodine can cause your unborn baby to develop a goitre (an enlarged thyroid gland).

Medications#

Pregnant women should be cautious about taking medications of any kind. Some can pass to the baby through the placenta and cause birth defects or miscarriage. Avoid any over-the-counter medication unless advised by a doctor who knows you are pregnant. In particular, some medications commonly used to treat traveler’s diarrhea are dangerous during pregnancy. Also avoid alcohol and any social or recreational drugs.

Key points#

• An important exception to the vaccine warnings is the influenza vaccine, which can be safely given during pregnancy
• A pregnant woman who catches malaria risks miscarriage, premature labor and stillbirth
• The risk of DVT is increased in pregnancy, for example if a family member has had a DVT
• Research indicates the risk of DVT can increase by two or three times on a long-distance flight
• If you have an increased risk of DVT, discuss your travel plans with your doctor

Where to get help#