Advice for Pregnant Travellers
Pregnant women are in an altered state of health that requires practical consideration prior to travel. They are more at risk from malaria and the disease is more severe in pregnant women, with significant risk to both mother and baby.
Most live vaccines are preferably not given to pregnant women. Where there is a high risk of disease (eg Yellow Fever) specialist advice should be sought. If possible, pregnant women should delay travel to tropical areas, particularly those with a risk of malaria and/or yellow fever, until after their baby is born.
The association between infection with Zika virus and birth defects means that non-essential travel to areas with ongoing Zika virus transmission should be postponed by women who are pregnant or planning pregnancy.
Fluctuating hormone levels and the psychological impact of pregnancy (as regards changing routines and responsibilities) can impact a pregnant woman’s emotional well being; this could affect her capacity to cope with the stressful nature of travel. Pregnant women should therefore consider their emotional wellbeing whilst travelling and ensure that they have adequate support in place.
As with any traveller, pregnant women should be encouraged to research their intended destinations; this should include gathering knowledge of availability of medical treatment/facilities and any existing travel warnings. The Foreign and Commonwealth Office (FCO) website provides advice on availability of medical treatment/facilities and any travel warnings on an individual country basis.
It is essential that all early pre-natal examinations are carried out prior to travel in order to rule out any possible complications. If travelling in the last trimester, medical facilities should be able to manage complications of pregnancy, pre-eclamptic toxaemia, and caesarean section. It is also advisable that pregnant women know their blood group before departure. They should be aware that the blood supply may not be safe in some countries, with the risk of blood-borne infection (hepatitis B and C, HIV and Chargas disease, for example).
Pregnant women should also be aware that misunderstandings due to language barriers or cultural problems might make communication and therefore diagnosis and treatment more difficult than it would be at home.
Travel plans should be discussed with the GP or obstetrician well in advance of the intended departure date. Travellers should take a copy of their medical records including details of any pre-existing medical problems, any obstetric issues and blood group in case medical attention is needed while away.
In pregnancy, travel insurance policies should be checked to ensure both mother and unborn child are covered, and if delivery may occur while travelling, the infant should also be covered. Failure to notify travel insurance providers of pregnancy may nullify insurance cover. Additionally, it should be remembered that insurance policies are only as good as the medical facilities available.
Air travel is generally considered safe in uncomplicated pregnancy. However, women with high-risk pregnancies should seek medical clearance before travel.
Pregnant travellers should be aware:
- Most commercial airlines accept a pregnant traveller up to 36 week gestation. In multiple pregnancies, flying is generally permitted up to 32 weeks gestation. This can vary and travellers should check with individual airlines prior to booking.
- Some airlines require documentation from a traveller’s doctor or midwife to confirm they are in good health, the pregnancy is uncomplicated and the due date. This typically applies to those over 28 weeks pregnant; however, travellers should be encouraged to check the specific requirements with individual airlines.
- Flying during the first 12-15 weeks of pregnancy may be considered risky as miscarriage is more common during this early stage. Additionally, at this stage pregnant travellers may be suffering from pregnancy induced nausea and/or fatigue which could make travelling uncomfortable.
- Flying in the final months of pregnancy may also be considered risky as pregnancy induced conditions such as hypertension (pre-eclampsia) are more common from 28 weeks.
- Some experts believe that women are at a greater risk of deep vein thrombosis (DVT) during pregnancy and the postpartum period; these travellers should be advised of DVT prevention measures.
The Royal College of Obstetricians and Gynaecologists have produced an advice leaflet for pregnant women planning to undertake air travel: Air Travel and Pregnancy
Pregnancy does not prevent a woman from receiving vaccines that are considered safe and will protect her health and that of her unborn child. However, careful consideration must be taken to avoid the inappropriate administration of vaccines that could potentially harm the unborn child.
A general rule is that most recommended vaccines should be used if the risk of infection is substantial because both the mother and the baby could be at serious danger if the traveller were to contract infections such as such as typhoid and hepatitis. However, a careful risk versus benefit analysis is needed for every individual, and the decision on whether to vaccinate should be made in conjunction with the traveller.
Live Vaccines in Pregnancy
There is a theoretical concern that vaccinating pregnant women with live vaccines (including measles, mumps, rubella, varicella and yellow fever) may infect the foetus. However, there is no evidence that any live or inactivated vaccine causes birth defects.
Since there is a theoretical risk, live vaccines should generally be avoided during pregnancy. However, the use of live vaccines in pregnancy may be appropriate if travel is unavoidable and the risk of the disease is high. The risk versus benefit ratio of administering any live vaccine during pregnancy requires careful consideration, especially if travel is unavoidable, and the risk of exposure to disease is high. Expert advice should be sought before administering live vaccines in pregnancy.
Inactivated Vaccines in Pregnancy
Inactivated vaccines cannot replicate which means they cannot cause infection in either the mother or her unborn child. Most inactivated vaccines can be used if the risk of infection is high. However, the risk versus benefit ratio must be considered and inactivated vaccines should only be administered to pregnant women when rapid disease protection is required.
Malaria in pregnancy is associated with miscarriage, premature delivery, low birth weight, maternal and/or neonatal death. Where possible, pregnant women are advised against travel to known malaria risk areas during pregnancy.
As with all travellers, bite prevention is essential in the prevention of malaria. Pregnant women however, appear to be more attractive to mosquitoes; the use of insect repellents is paramount. DEET should not be used in concentrations higher than 50% during pregnancy.
Malaria Medication in Pregnancy
It is essential that pregnant women travelling to malaria risk areas are aware of their increased risk and are advised about the safest medication available. Pregnant travellers should seek travel advice from their GP in the first instance to discuss their risks.
Careful consideration must be given to the best antimalarial medication to recommend for a pregnant woman. Expert advice is necessary and a woman's GP may refer her to a specialist Travel Clinic for advice.
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