The number of people travelling to remote destinations for business or pleasure continues to grow. Women who are pregnant or are planning to conceive are no exception. Pregnant women (like any other traveller) are exposed to infectious diseases and may have difficulty obtaining adequate medical care. There are wide variations in medical training and childbirth in foreign countries. Whenever possible, use extreme caution when travelling to a remote area or developing country due to the lack of first-class medical facilities and the risk of tropical diseases, such as malaria, which are more serious for pregnant women and babies.
1. Medical Assessment. Discuss your plans with your doctor as well as a travel medicine expert. If this is your first pregnancy or you have had problems during pregnancy or delivery before, you may need to defer either your pregnancy or your trip! Avoid travel if you have high blood pressure, vaginal bleeding or any other abnormal symptoms.
A comprehensive medical and dental assessment is recommended prior to your departure. TMCP can provide contact numbers for English-speaking doctors and approved overseas medical facilities. A thorough knowledge of available medical and evacuation services is important. Information about the local environment and climate, the quality of accommodation and food and water sources is very useful. The lack of adequate medical facilities in developing countries to care for problems during pregnancy and to care for premature and full-term babies cannot be emphasised enough. A letter from your doctor detailing your medical history and results of any tests performed out should also be carried with you.
2. Medical Insurance. Pregnancy in general carries a higher medical risk than normal so obtaining adequate medical and travel insurance is important. Ensure in advance that complications relating to pregnancy and birth are covered, as well as medical care for the new baby. Some insurance policies will terminate benefits if care is sought from medical facilities that are not approved. Have a clear understanding of what your medical insurance will and will not cover during your travels abroad.
3. Immunisations. Depending on your journey, certain vaccinations may be recommended. Ideally your vaccination schedule should be completed at least three months prior to conception. Certain vaccines, especially live vaccines, may place the unborn baby at risk, particularly during the first three months of pregnancy. However, the benefit of vaccination usually outweighs the risk when the potential for disease exposure is high and infection would be dangerous to mother and baby. Please discuss this with your doctor.
Malaria requires particular attention as this potentially fatal disease can also affect the foetus, resulting in miscarriage or stillbirth. Malaria is usually more severe in pregnancy. Also, there are fewer drugs available to pregnant women for preventing and for treating malaria. Ideally pregnant women should avoid travel to malarial areas. Where this is not possible, meticulous mosquito avoidance measures are paramount. No prophylaxis is completely effective, therefore sound knowledge of mosquito avoidance tactics are important, such as staying in well screened or air-conditioned accommodation, and remaining indoors from dusk to dawn when malaria transmitting mosquitoes are most active.
Certain antimalarials, such as chloroquine and proguanil, are safe during pregnancy. However, in many countries where there is chloroquine-resistant malaria, these drugs provide less than optimum protection. Some drugs are contraindicated in pregnancy and breastfeeding, such as doxycycline. Your travel medicine specialist can advise you on the safety and efficacy of antimalarial drugs and in which areas you are at risk.
The safest time to travel is during the middle third of your pregnancy, before you get too big and after morning sickness has finished (hopefully!). Current guidelines from most international airlines permit travel up to 36 weeks gestation, provided there are no other risk factors (eg. high blood pressure, twin pregnancy). Airlines sometimes require a letter from your doctor indicating the expected delivery date and confirming your state of health.
During your flight, long periods of sitting should be avoided. An aisle seat preferably should be selected. Relax and tighten your leg muscles when seated to avoid the risk of developing blood clots in the legs. Try to get out of your seat and have a short walk at least once every hour. The combination of altitude and pregnancy interferes with venous circulation and can cause swelling of ankles and feet. Elastic support stockings may be worn and elevate your feet when possible. Choose a non-smoking flight if possible.
Dry cabin air causes dehydration so drink plenty of bottled water or juice but avoid alcoholic beverages. Carbonated drinks can cause bloating and avoid foods (e.g. cabbage, onions and beans) that cause uncomfortable flatulence!
Any fever increases the risk of miscarriage and premature labour and should be investigated and treated as soon as possible. Diarrhoea is particularly common in travellers. Ensure your water is sterilised but try to avoid prolonged use of iodine treated water as this can cause thyroid problems for both mother and foetus. In the event of illness, temperature control and adequate fluid intake are vital to the well being of both mother and baby.
Medications used in the prevention and treatment of traveller's diarrhoea may pose a risk to the pregnant traveller and are generally not recommended. An antibiotic may be indicated for certain serious illnesses after consultation. However, antibiotics are not appropriate for most minor respiratory and gastrointestinal problems. Seek medical advice before self-treatment where possible.
Certain holiday activities like scuba diving, horse riding and travelling to high altitudes should be avoided.
A comprehensive medical kit can be a lifesaver where there is no doctor close to hand. The medical staff at TMCP can advise you of the appropriate supplies to carry depending on your destination and individual concerns, and also tell you which medications are safe to take during pregnancy and breastfeeding. Medical supplies may include paracetamol, fluid and electrolyte supplements, antibiotics, antacids, fibre supplements, anti-fungal creams, tea tree oil as well as sterile dressings and sterile needles and syringes. Don't forget your pre-natal vitamins!