Minimizing Risk for Pregnant Travelers

On February 12, 2019 in Risk, Travel Trends by GBTA Risk Committee

Pregnant travelers face numerous considerations that most travelers do not need to bear in mind. However, with planning and preparation, pregnant women can safely travel to most locations. Expectant mothers should schedule an appointment with a travel medicine specialist at least four to six weeks before travel. The travel medicine practitioner may need to collaborate with the obstetrician to coordinate care and ensure the best travel plan. For women in their third trimester, or those who will be overseas during their third trimester, consider locating a medical facility at the destination that can manage pregnancy complications, delivery, caesarean section, and neonatal problems.

Pregnant travelers, like all travelers, should ensure that they have health insurance that covers them while they are abroad. Be sure the policy covers pregnancy, pregnancy complications, and care of the infant if the baby is delivered overseas. Evacuation insurance, including coverage for pregnancy-related complications, is also recommended, especially if traveling to a remote area.

Vaccinations

Because some vaccines carry the risk of side-effects that could potentially affect the fetus, carefully review the risks and benefits of each immunization. Ideally, all women who are pregnant should be up-to-date on their routine immunizations prior to pregnancy. In general, pregnant women should avoid live vaccines and becoming pregnant within one month of having received one; however, no harm to the fetus has been reported from the accidental administration of these vaccines during pregnancy.

If not previously received, the tetanus, diphtheria, and pertussis (Tdap) vaccine is recommended during pregnancy to protect women and provide antibodies to the newborn. This vaccine should be given in the second or third trimester. Pregnant women traveling during the influenza season at their travel destination should be vaccinated with an inactivated vaccine. This can be administered in any trimester and is especially recommended for those with chronic diseases and an increased risk of influenza-related complications. Individuals should consult with their physician before obtaining any vaccination.

Diseases

Malaria can be much more serious in pregnant women than in non-pregnant women. Malaria during pregnancy is associated with many complications including high rates of maternal and fetal mortality. Due to increased risk of severe disease, pregnant women should avoid or delay travel to malaria-endemic areas. If travel is unavoidable, expectant mothers should take precautions against mosquito bites and consider prophylactic medication.

Zika virus transmission can occur between currently infected pregnant women and their fetuses; research suggests Zika virus infection during pregnancy may result in “congenital Zika syndrome,” which describes a pattern of conditions found in babies infected with Zika virus in utero. These include microcephaly (an abnormally small head) and damage to the developing brain, eyes, muscles, and joints. Babies born with congenital Zika syndrome may not display all these conditions.

Pregnant women should take strict precautions against mosquitoes, ticks, and other insects in areas that are endemic for arboviruses such as dengue fever, chikungunya, Zika virus, and tick-borne encephalitis. Preventive measures include use of bed nets, use of insect repellents, and wearing protective clothing.

Pregnant women are also more likely to acquire respiratory diseases and urinary tract infections. These illnesses may also be more severe in pregnancy. Pregnant women should ensure they are taking basic health precautions such as good hand hygiene.

Food and Water Safety

Pregnant women may be more vulnerable than non-pregnant women to dehydration after developing traveler’s diarrhea or other gastrointestinal infection. Pregnant women should strictly maintain hand hygiene and make prudent food and beverage choices. Pregnant women should only eat food that is cooked and served hot, and avoid cold food or dishes that have sat at room temperature. Expectant mothers should not consume undercooked meat or fish, unpasteurized dairy products, or anything containing ice. Only eat fresh fruits and vegetables that you have peeled and washed yourself. Drink only bottled and sealed beverages. Carbonated beverages are considered safer. Do not use iodine-containing compounds to purify water, as they could cause negative effects to the fetal thyroid. If diarrhea develops, drink plenty of safe fluids.

Environmental issues

Pregnant women may be more affected by air pollution than non-pregnant women. Additionally, as body temperature regulation is less efficient during pregnancy, temperature extremes may cause additional stress and heat stroke or heat prostration, or harm to the fetus. High temperatures may also cause fainting. Pregnant women should seek air conditioned facilities during extreme heat.

Travel to altitudes of 1,800 meters (6,000 feet) is usually safe, if ascent is gradual. A remote location and the possibility of dehydration pose a greater risk for the pregnant traveler. Planned travel to altitudes above 1,800 meters (6,000 feet) should be discussed with the travel clinic physician and obstetrician.

Transportation Issues

Some airlines have rules restricting travel toward the end of pregnancy. Know your airline’s restrictions. Some airlines require a letter from a medical provider stating that the woman is fit to travel and with the expected delivery date to confirm the length of pregnancy. Generally, international flight is not recommended after 35 weeks and domestic flight after 36 weeks. Some contraindications to airline travel during pregnancy include anemia and a high-risk pregnancy. While flying, pregnant women should wear the seat belt low around the pelvis; move around frequently, stretch, do isometric leg exercises, wear graduated compression stockings to help improve blood circulation; and drink non-alcoholic beverages to avoid dehydration.

Most cruise lines restrict travel beyond 28 weeks of pregnancy, with some restrictions as early as 24 weeks. Some cruise lines require a letter from a medical provider stating that the woman is fit to travel and with the expected delivery date to confirm the length of pregnancy. Pregnant women should check their specific cruise line’s restrictions. Pregnant women on cruises should be aware of the risk of motion sickness, gastrointestinal disease, respiratory disease, and the risk of falls on a moving vessel.