Further Health Considerations for Pregnant Travellers

Travelling during pregnancy has its own set of challenges and potential risks. Each pregnancy is unique, and every woman faces different challenges during pregnancy yet harbours a general apprehension about the safety of travel during pregnancy. The key to safe prenatal travel is lots of planning and careful preparation. Planning the itinerary and exploring the right frequencies, waiting time, and exertion at each transfer is necessary, with at least two hours between connecting flights.

Pregnant women need to make sure that they are not exposed to food and waterborne diseases, vector-borne illnesses, animal bites, malaria, and yellow fever during travel, which can harm the fetus. While dealing with impending motherhood, pregnant women should be aware of warning signs and take precautions that promise the safety of both the mother and the baby, while at the same time tailoring the travel according to their physical health and desires. Pregnancy is a time for physical and emotional preparations for the new addition to your family.

For many pregnant women, this time includes a fair amount of travel. Like every decision in pregnancy, it is not a concern of a single organ, a single drug, or a definite lab investigation; it is a situation that involves every aspect of history, conduct, examination, and therapy. Hence, while we embark upon the issue of travel during pregnancy, let us go stepwise, one by one, through the details of the condition. While deciding if a given patient will have safe passage through the skies or not, we need to address ourselves to a raft of queries, while on her part, she must adjust her answers to include the physical impact and the emotional aspects of "how does it feel to be pregnant now?"

Given all that might occur when a woman is pregnant, which could be induced or flared up by travel, very few of the complications related to travel in the pregnant woman require significant medical or surgical intervention.

Risk Assessment for Pregnant Travellers

A prerequisite for any travel, especially during pregnancy, is a thorough risk assessment of various travel and health threats. A tailored risk assessment and counselling of pregnant travellers are essential components of pre-travel advice and should be performed by well-trained healthcare professionals. These professionals should be up to date on the latest travel safety advice.

The maternal and fetal risk of adverse travel events is considered carefully in light of generally higher risks of adverse outcomes in pregnancy, particularly for prolonged or frequent travel. Risk assessments should be kept in mind as the itinerary changes. Therefore, it is recommended that each pregnant traveller return to the clinic if travel plans change to undergo a review of the itinerary and possible advice modification.

Expanding her medical history, a detailed and up-to-date travel plan of potential journey itinerary should be carefully reviewed. Important details include the upcoming travel period and duration of each destination, the type of travel, the means of transport used, planned activities, and the duration and intended destination of stopovers. An assessment of possible risk factors in a specific destination must be made in light of the specific vulnerability, for example concerning local climate which may cause additional health vulnerabilities.

Understanding the availability of adequate healthcare facilities in each setting visited by the pregnant woman is extremely important. Urgency or evacuation services and their limitations are noted. Such specific information and advice can only be given through personal travel medicine advice and a risk assessment by a healthcare professional who is familiar with the patient's medical and obstetric history.

Consulting with Healthcare Providers

Travellers regularly seek the advice of healthcare providers who understand travel health to help determine their needs, whether or not to proceed with their travel plans and to receive preventive medications and other supplies. Healthcare providers can evaluate a person’s medical status and recommend vaccinations and medications based on their medical history. Healthcare providers can tailor the recommendations and advice to a pregnant person based on the stage of pregnancy and any medical conditions.

Many healthcare providers counsel pregnant persons on how to minimize the risks of overseas travel. Consulting with a healthcare provider and providing up-to-date information on travel plans are essential first steps in any pre-travel health visit. A person should share as much information as possible related to their health and travel plans, concerns, and past experiences since these factors may help the provider tailor their advice.

A healthcare provider can evaluate a patient's medical status and make recommendations based on their health issues. They may discuss safe activities while travelling and symptom management for common, non-serious travel-associated conditions. They may also discuss health issues that could affect the safety, duration, or overall feasibility of travelling while pregnant. Pregnant persons may also have health needs beyond those common to travellers.

It can be helpful for pregnant persons to carry a summary of their medical records, past obstetric or pregnancy history, and healthcare provider contact information, with pregnancy-related records and emergency contacts located separately from the visas, itineraries, and travel documents. Documenting any pregnancy complications or comorbidities and discussing the impact on travel with healthcare providers can help develop a tailored travel plan.

Reviewing Travel Itinerary

When pregnant, it is even more important to properly gather as much detail about the travel itinerary as possible. The duration of any part of the itinerary, such as time spent in transportation or airports, should be taken into consideration when assessing the health risks it may impose. The increased discomfort of travel typically has more to do with travel time than the mode of transportation.

Some health concerns are implicated in common modes of transportation, and finding alternative options plays an important role in prevention. During trip preparation, make note of the facilities available at the destination city where you can have your blood pressure, urine, and symptoms assessed. The location where the health risks of the trip can be treated might not necessarily be the final destination at all. Larger airports and transportation-hub cities can provide quicker, more thorough medical assessments and better emergency care.

Some pregnant women might want to evaluate the off-site facilities before selecting their destination. It is a good idea to have an understanding of what kind of facilities and remote medical care are available during your travel before you find yourself in distress. In anticipation of exhaustion or shortness of breath, review your layover city's comfort and amenity offerings. You may want to consider bringing a backrest and earplugs. Travelers may also benefit from a discussion about the special amenities and seating that may be provided on airlines, trains, and buses.

Energy conservation and reducing discomfort are significantly facilitated by proper seating. Ensure that the travel plan accounts for the fact that some countries and modes of transportation have limitations for flying in an emergency, such as how far along you can be in pregnancy before you are considered at increased risk. Surrogates and IVF recipients frequently have additional restrictions.

Assessing Destination-specific Risks

Pregnant travellers should consider destination-specific risks alongside general travel considerations such as travel activities, duration of travel, and available resources in the areas they will be visiting. An area of the world, a country, or a specific region within a country will have health risks that may change throughout pregnancy and from day to day due to issues such as environmental hazards.

People who are on vacation without pregnancy considerations may tolerate health threats more than pregnant travellers. To make informed decisions about possible itineraries, pregnant travellers can choose to consider these factors relevant to determining health threats. They would be less able to access travel health care and have fewer options for addressing problems if they become ill in regions with fewer healthcare resources than they are used to, so planning a trip that avoids known health threats is wise. They may also wish to plan their trip around the undesirability of becoming ill in countries, regions, or cities where the public health system is overburdened.

Researching these issues in a prospective destination area can help pregnant travellers decide when and if travel would fit their health objectives. Being forewarned also allows the traveller to prepare ahead of time to avoid or mitigate the effects of potential health threats. Checking health advisories before travel and during health-preparation meetings can also be beneficial for pregnant travellers.

Vaccinations and Medications

Pregnant travellers should have an initial vaccination assessment, typically based on their destination. Additional risk factors, such as substandard medical facilities or pre-existing medical conditions, should also be considered. Each destination has its infectious disease and vaccine risks. Consult a travel health provider to understand which vaccines are recommended based on your travel itinerary and current global health advisories.

• Vaccinations: Pregnant women are susceptible to certain vaccine-preventable diseases. Therefore, they must be counselled on which are safe and effective to receive while pregnant. Inactivated vaccines are provided to pregnant women; the most common are the Tdap and seasonal influenza vaccines.

• Pregnant travellers need to be aware that they should contact their healthcare provider to discuss which vaccines are necessary based on their travel itinerary, including the health advisories in the destination country and pre-existing medical conditions.

• Medications: Travelers should understand which over-the-counter and prescription medications are safe to take while pregnant. For example, acetaminophen is safe to use for pain and fever. For nausea, both dimenhydrinate and diphenhydramine are safe to use.

• Consult with a travel health provider to discuss pre-travel medications that are safe and can be used in pregnancy. Unfortunately, many of the most common travel medications are not thought to be safe during pregnancy, but alternatives can be discussed.

Preparation and management are key for pregnant travellers. By discussing your medical history, as well as your upcoming travel plans and itinerary with a travel health professional, they can provide guidance on the most up-to-date vaccine and preventative health information based on important specifications and your health status. Be sure to seek confirmation well in advance, as some vaccinations may require a series of doses separated by weeks or months.

Vaccination Recommendations

While generally highlighted as a part of pre-travel preparations, safe and appropriate vaccination recommendations are possibly most pertinent for some groups, such as pregnant women who may face substantial risks from vaccine-preventable diseases. Notably, hypersensitivity to substances contained in the vaccine affects up to 8% of pregnant travellers in our study, who either were or may have been pregnant when they travelled, most without seeking pre-travel advice and care. It is essential to present timely information to pregnant women concerning immunization against yellow fever pre- and post-conception, as well as the recommendation to delay conception following an epidemic; there ought to be similar recommendations for other live vaccines when discussing Zika vaccination settings.

Pregnant women usually tend to confide their pregnancies to healthcare providers initially, and they are thus suggested to be immunized against ailments that may have detrimental effects throughout their pregnancies. Influenza vaccination, preferably with the inactivated trivalent influenza vaccine, is very useful for pregnant women as well as for women considering becoming pregnant. Immunization against other ailments can be beneficial during pregnancy, such as diseases like measles or pertussis, or diseases that may occur in particular settings, such as meningococcal meningitis if the expectant mother is a healthcare worker, or other diseases depending on where she resides.

All pregnant women without contraindications should receive the recommended vaccines, preferably pre-travel. For live vaccines that are not recommended during pregnancy, the focus must be on instructing women on the need to delay pregnancy. Information on the safety of live vaccines given inadvertently before pregnancy may allow decisions to terminate pregnancy or delay conception to be made.

Safe Medication Use

Just as during travel, it’s important to be aware that some medications are safe to use while pregnant and some pose risks to a mother and fetus. Again, it is imperative to consult your healthcare provider for medication advice. Medications safe to use in pregnancy include acetaminophen, penicillins or cephalosporins, metronidazole after the first trimester, and insulin for women with gestational diabetes. Medications to avoid pregnancy include isotretinoin with a severe risk of birth defects, some antibiotics, and Coumadin or heparin.

Maintenance medication use needs to be both continuous and consistent in the timing of doses. Travelling throughout time zones could affect the timing of medications. Increased elevation can exaggerate medication side effects. It is important to know if your medical condition could be affected by travel. Considering any of the above, it is important to plan and keep a record of your medications, the dose and time given, what conditions they are being used for, and the prescribing healthcare provider and contact number so that in case of an emergency away from home, medical care can be provided ensuring safe and effective medical care.

Precautions and Tips for Pregnant Travellers

Pregnant travellers can use several precautions and tips to make travel more enjoyable and lower the risk of medical difficulties. Pregnant women should maintain proper hygiene and follow food safety guidelines while travelling to help prevent illness. If you are driving, pregnant travellers should try to travel with at least one other person who can alternate with them behind the wheel. Automobiles should be driven with air conditioning on and be especially well-ventilated.

Built-in and third-party evening driving systems are less likely to interfere with a pregnant woman's sleep since they generally encourage more frequent driving stops. Built-in GPS systems and smartphone applications can help plot out driving journeys that take into account current fatigued driving guidelines. Electronic and hand-held written travel itineraries and travel apps can help pregnant travellers avoid losing their way and incidental stops due to disorientation.

Sitting for long periods during travel and pregnancy increases the risk of deep vein thrombosis (DVT). DVT occurs when blood flow in the legs slows while sitting or standing, causing blood to pool in the legs and increasing the risk of blood clot development. Inflatable footrests and regular stretching to avoid DVT during travel are tips that can be given to pregnant travellers. Travelers who are pregnant are more likely to experience dehydration and other heat-related difficulties from the sun and hot weather.

Pregnant women should protect their skin by using a sunblock of SPF 30, a wide hat, and sunglasses that block UVA and UVB rays and wear a lightweight, long-sleeve shirt and pants. Pregnant travellers should also safeguard themselves by consuming adequate water or sports drinks and avoiding shoes that make it difficult to move on hot surfaces. When travelling during hot weather or the summer season, pregnant travellers should be sure to put on protection against UVA and UVB rays and drink plenty of water. Some pregnant women's bodies may not be able to handle rising temperatures outside, and they may feel unwell or delicate as a result. It's a good idea for pregnant women to go indoors and unwind if they get sweaty and uncomfortable when outside.

Hygiene and Food Safety

Transmission of infectious illnesses via food or water can cause significant symptoms and complications during pregnancy. Caution with food and water will aid in reducing the risk of gastrointestinal infections that affect the expectant mother. Bacteria, parasites, and viruses infect many individuals via ingestion, particularly concerning foods that are raw, undercooked, or otherwise improperly handled. Generally speaking, foods should be thoroughly cooked and stored safely. Cooking temperatures are important to consider and should be at least 85 °C.

Water quality is also of concern since it may be a source of consumption despite being used in food preparation and other activities, such as brushing teeth. Public fountains pose a greater risk of water contamination. Raw foods like vegetables and fruits that are not peeled before consumption may pose concerns, as the edible portion may have been inappropriately handled, washed, or grown in unclean environments.

Meat should be carefully selected and cooked, with added caution regarding marinades for a prolonged period at room temperature. High-risk foods should generally be avoided, including undercooked or raw seafood, raw or undercooked eggs, and ceviche. Specific countries with noted low standards of food safety may warrant additional precautions in addition to the previously mentioned generalized advice, such as food being free from bacteria, parasites, toxins, and chemicals. Sometimes, special advice, such as vaccinations for contaminated raw milk, might also be of importance depending on the destination.

Practices of personal hygiene, such as frequent handwashing, especially after exposure to potentially contaminated environments or objects, should be encouraged. If running water is not available, hand sanitisers with an alcohol content of at least 60% are a useful alternative, provided that the hands are not visibly soiled. Public showers, bathrooms, and other areas where one must touch surfaces and objects that may be contaminated can be of concern, and protective foot coverings may be of benefit. Additionally, used often by a variety of people daily, these public spaces should be considered high risk, and protective practices like hand sanitation should be used when exiting.

Preventing Deep Vein Thrombosis

One essential consideration for long journeys is to take measures to prevent deep vein thrombosis (DVT), which is a blood clot in one of your deep veins. DVT happens more often in legs than arms, and there are increased risks of getting DVT when you are pregnant and/or going on a long-distance journey, as you are sitting still for a long time. If your journey will last more than 2–3 hours, try to do the following:

• Regular movement, for example, walking around the plane, stretching, and changing the positions of your legs every once in a while to keep the blood flowing. If you are travelling by car or other forms of transport, try to take a break every 2 hours. Many mothers-to-be feel the need to pass urine more often. This is common, and you can ask an assistant to show you where the restrooms are.

• Drink plenty of water and other non-alcoholic beverages. For example, one-half to two cups of fluid every hour is a good goal for most women. Check with your doctor or midwife to make sure this is the right amount for you. Dehydration can occur if you don’t drink enough, so try to drink more fluid than usual on the go.

Also, wear your seatbelt, but do not let it make the strap over your legs too tight since this might slow down the blood flow from your legs. For added protection, you can wear graduated compression stockings. These stockings are tight at the ankle and become looser when they reach the knees or higher up to help with blood flow. Plan to wear comfortable clothes and shoes if you need to stand or walk in any line while travelling.

Signs of DVT that you should recognize and tell your doctor or midwife about early are:

• Sudden swelling in one of your legs

• Unexplained pain in your leg or pelvis

• Redness in your leg or pelvis. Prioritizing these empowers mothers to decide.

Sun Exposure and Heat Precautions

As pregnancy progresses, you may notice that you are more sensitive to the sun than normal. Whether you are on the beach and want to maintain a pregnancy glow or in a cold climate and embrace vitamin D, sun protection is to be taken very seriously! Wear a hat, and sunglasses, and apply sunscreen regularly. Look for shade when out in the sun. Wear loose clothing that covers your skin.

Drink up – and be sure to stay hydrated. Signs of dehydration include nausea and vomiting, muscle cramps, weakness, confusion, lack of sweat, and a rapid heartbeat. If you experience any of these symptoms, move to a cooler location, drink fluids, and remove any excess clothing. Fainting should not be mistaken for being tired. Pregnant travellers should take all precautions to protect themselves from the sun and heat, as the consequences can be more severe for expecting mothers.

If touring an area in a hot climate, use caution and plan to limit prolonged sun exposure on all days you are there. In addition, from 10:00 a.m. to 4:00 p.m. (the hottest time of the day), plan to be in air-conditioned buildings to recover from the heat. Provide adequate time for visiting while strolling the city (early in the day or late in the afternoon). Take regular breaks in air-conditioned buildings or under the shade to drink fluids, particularly water, throughout the day.

Emergency Response and Contingency Planning

Medical emergencies can happen anytime, and it is important to have a plan for seeking medical care or evacuation in case of a medical emergency when travelling. Pregnant women, especially those with high-risk pregnancies, need to have a contingency plan. Travel healthcare insurance may offer support at times of medical emergency and may help coordinate a medical evacuation with the treating doctor and seek international assistance if necessary.

The medical assistance program may also recommend or appoint physicians on the ground in the place of local medical care in case of emergency or evacuation. Expectant mothers who are travelling should wait for the insurance company's input before seeking medical assistance, given that this will normally be coordinated. The insurance business should be approached as soon as possible to seek urgent guidance on the best course of action.

When travelling, they should carry a personal medical file that details the expected treatment and guarantees. They may also carry some medications that have been recommended for them, such as pain medication. A medical alert bracelet or necklace should be worn by pregnant women with any medical conditions or allergies. They should investigate the closest hospitals in their destination and how to contact them before booking travel. Expectant mothers should notify either a family member or friend at home of their itinerary and how they can be reached in the event of an emergency.

In case of emergency, expectant mothers will psychologically be prepared to stay calm and get medical help. Staying proactive reduces anxiety when travelling because they already have options in place. Knowing they have access to medical experts if anything goes wrong helps to ensure the safety of pregnant travellers and gives them peace of mind.

For further information on other travel-related health considerations, download our ebook “Travel Smart: Your Essential Guide to Medicine on the Go”. The best way to stay safe and healthy during your travel is to be informed and minimise the health dangers related to travel for work, business, or leisure. You can download it by clicking HERE.