According to the American College of Obstetrics and Gynecology, the safest time for pregnancy travel is during the second trimester (18 through 24 weeks) when you are usually feeling your best and are in the least danger of experiencing a miscarriage or premature labor. It's generally advised that women in their third trimester should stay within 300 miles of home because of concerns about access to medical care in case of problems such as hypertension, phlebitis or false premature labor. When making the decision to travel, it's important to consider the potential problems associated with international travel, as well as the quality of medical care available at your destination and during transit. It's a good idea to consult with your health care provider before making any travel plans.
Typical problems that you might encounter are the same as those experienced by many pregnant women: fatigue, heartburn, indigestion, constipation, vaginal discharge, leg cramps, increased frequency of urination and hemorrhoids.
8 symptoms that need immediate medical attention
1. Bleeding
2. Abdominal pain or cramping
3. Passing of clots or tissue
4. Contractions
5. Ruptured membranes
6. Excessive swelling of your legs
7. Headaches
8. Visual problems
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6 guidelines for the pregnant traveler
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Learn more about air travel during pregnancy
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Find out all you need to know about traveler's diarrhea and pregnancy
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Learn which immunizations are recommended
Get information about your specific destination from the Centers for Disease Control and Prevention
6 guidelines for the pregnant traveler
1. Avoid potentially contaminated water and food. Pregnant travelers should eat only well-cooked meats and pasteurized dairy products, while avoiding preprepared salads. This will help to avoid diarrhea, as well as infections such as toxoplasmosis and listeria, which can cause serious problems during pregnancy.
2. Don't travel alone. It's advised that you travel with at least one companion.
3. Don't miss your scheduled prenatal visits. Determine beforehand whether prenatal care will be required abroad and, if so, who will provide it.
4. Take a close look at your health insurance coverage. Make sure before traveling that your health insurance is valid while abroad and during pregnancy, and that the policy covers a newborn should you give birth. Also, a supplemental travel insurance policy and a prepaid medical evacuation insurance policy should be obtained, though many may not cover pregnancy-related problems.
5. Check into available medical facilities at your destination. For a woman in the third trimester, medical facilities should be able to manage complications of pregnancy and should be able to perform a cesarean section.
6. Know your blood type.
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Learn more about air travel during pregnancy
Page Four:
Find out all you need to know about traveler's diarrhea and pregnancy
Page Five:
Learn which immunizations are recommended
Air Travel during Pregnancy
Commercial air travel poses no special risks to a healthy pregnant woman or her unborn baby.
If you're looking for the most space and comfort you might want to request an aisle seat at the bulkhead, but a seat over the wing in the middle of the plane will give you the smoothest ride. Be sure to get up and walk every half hour during a smooth flight and flex and extend your ankles frequently to prevent phlebitis. The safety belt should always be fastened at the pelvic level. Bring along plenty of water to drink because of the dehydrating effect of the low humidity in aircraft cabins.
Each airline has policies regarding pregnancy and air travel. It is always safest to check with the airline when booking your reservations because some will require medical forms to be completed. Domestic travel is usually permitted until the pregnant traveler is in her 36th week of gestation and international travel may be permitted until the 32nd week. Be sure to carry documentation stating your expected due date.
Contraindications to flying include severe anemia (hemoglobin, 0.5 grams per deciliter), sickle-cell disease or trait, a history of thrombophlebitis or placental problems; however, supplemental oxygen can be ordered in advance.
Page Four:
Find out all you need to know about traveler's diarrhea and pregnancy
Page Five:
Learn which immunizations are recommended
Travelers' Diarrhea during Pregnancy
It's important to be careful about what you eat and drink when traveling during pregnancy because dehydration from travelers' diarrhea can lead to problems with inadequate placental blood flow.
Pregnant travelers should eat only well-cooked meats and pasteurized dairy products, while avoiding preprepared salads. This will help to avoid diarrhea, as well as infections such as toxoplasmosis and listeria, which can cause serious problems during pregnancy.
It's important to boil potentially contaminated water and avoid long-term use of iodine-containing purification systems. Iodine tablets can probably be used for travel up to several weeks, but congenital goiters have been reported in association with the administration of iodine-containing drugs during pregnancy. Pregnant women should be advised not to use prophylactic antibiotics for the prevention of traveler's diarrhea.
Oral rehydration is the recommended therapy for traveler's diarrhea. The combination of kaolin and pectin may be used, but loperamide should be used only when necessary. Bismuth subsalicylate compounds are contraindicated because of the theoretical risks of fetal bleeding from salicylates and teratogenicity from the bismuth. The antibiotic treatment of traveler's diarrhea during pregnancy can be complicated. An oral third-generation cephalosporin may be the best option for treatment if an antibiotic is needed.
Page Five:
Learn which immunizations are recommended
Immunizations and the pregnant traveler
Because there are theoretical risks to your unborn baby from vaccination, it's crucial to carefully review the risks and benefits of each immunization. Ideally, all pregnant women should be up to date on their routine immunizations. In general, pregnant women should be advised to avoid live vaccines and to avoid becoming pregnant within three months of having received one; however, no harm to the unborn baby has been reported from the accidental administration of these vaccines during pregnancy. Current information on vaccine safety during pregnancy is subject to change and can be verified at the Centers for Disease Control and Prevention Website.
Diphtheria-Tetanus
The combination diphtheria-tetanus immunization should be given if the pregnant traveler has not been immunized within 10 years. Although no evidence exists that tetanus and diphtheria toxoids are teratogenic, waiting until the second trimester of pregnancy to administer is a reasonable precaution for minimizing any concern about the theoretical possibility of such reactions.
Measles, Mumps and Rubella
The measles vaccine, as well as the measles, mumps and rubella (MMR) vaccines in combination, are live virus vaccines and are contraindicated in pregnancy. However, in cases in which the rubella vaccine was accidentally administered no complications have been reported. Because of the increased incidence of measles in children in developing countries, and because of the disease's communicability and its potential for causing serious consequences in adults, it is advisable to recommend that nonimmune women delay traveling until after giving birth, when immunization can be given safely. If a pregnant woman has a documented exposure to measles, immune globulin should be given within a six-day period to prevent illness.
Poliomyelitis
Although no adverse effects of IPV have been documented among pregnant women or their fetuses, vaccination of pregnant women should be avoided on theoretical grounds. However, if a pregnant woman is at increased risk for infection and requires immediate protection against polio, IPV can be administered in accordance with the recommended schedules for adults. Paralytic disease can occur with greater frequency when infection develops during pregnancy. Damage to the unborn baby has also been reported, with up to 50 percent mortality in neonatal infection.
Hepatitis B
The hepatitis B vaccine may be administered during pregnancy. On the basis of limited experience, there is no apparent risk of adverse effects to developing fetuses when hepatitis B vaccine is administered to pregnant women (CDC, unpublished data).
Influenza
Because of the increased risk for influenza-related complications, women who will be beyond the first trimester of pregnancy (greater than 14 weeks' gestation) during the flu season should be vaccinated. Pregnant women who have medical conditions that increase their risk for complications from influenza should be vaccinated before the flu season -- regardless of the stage of pregnancy.
Travel-Related Immunization during Pregnancy
Yellow Fever
The yellow fever vaccine should not be given to a pregnant woman unless travel to an endemic or epidemic area is unavoidable. In these instances, the vaccine can be administered. Although concerns exist, no congenital abnormalities have been reported after administration of this vaccine to pregnant women.
If traveling to or transiting regions within a country where the disease is not a current threat but where policy requires a yellow fever vaccination certificate, pregnant travelers should be advised to carry a physician's waiver, along with documentation (of the waiver) on the immunization record.
In general, pregnant women should be advised to postpone until after delivery (when vaccine can be administered without concern of fetal toxicity) travel to areas where yellow fever is a risk. However, a nursing mother should also delay travel because the neonate cannot be immunized due to the risk of vaccine-associated encephalitis.
Hepatitis A
The safety of hepatitis A vaccination during pregnancy has not been determined; however, because hepatitis A vaccine is produced from inactivated hepatitis A virus, the theoretical risk to the developing fetus is expected to be low. The risk associated with vaccination should be weighed against the risk for hepatitis A in women who may be at high risk for exposure.
Typhoid
The safety of the oral Ty21a typhoid vaccine in pregnancy is not known. It is not absolutely contraindicated during pregnancy, according to the Advisory Committee on Immunization Practices (ACIP). Nonetheless, the Vi capsular polysaccharide vaccine (ViCPS) injectable preparation is the vaccine of choice during pregnancy because it is inactivated and requires only one injection. With either of these, the vaccine efficacy (about 70 percent) needs to be weighed against the risk of disease.
Meningococcal Meningitis
The polyvalent meningococcal meningitis vaccine can be administered during pregnancy if the woman is entering an area where the disease is epidemic. Studies of vaccination during pregnancy have not documented adverse effects among either pregnant women or neonates. Based on data from studies involving the use of meningococcal vaccines and other polysaccharide vaccines administered during pregnancy, altering meningococcal vaccination recommendations during pregnancy is unnecessary.
Rabies
Because of the potential consequences of inadequately treated rabies exposure, and because there is no indication that fetal abnormalities have been associated with rabies vaccination, pregnancy is not considered a contraindication to postexposure treatment.
Japanese Encephalitis
No information is available on the safety of Japanese encephalitis vaccine during pregnancy. It should not be routinely administered during pregnancy, except when a woman must stay in a high-risk area. If not mandatory, travel to such areas should be delayed.
Source: Centers for Disease Control and Prevention
