by Dr Milton Lum
Most pregnant women can travel safely even to distant places. There are several factors that need to be considered when travel decisions are made. They include the obstetric and vaccination status of the woman, the mode of transport, medicines and travel insurance.
Other factors that need to be considered are the particular features of air travel and certain activities like diving which impose special physical demands on a pregnant woman's body.
It is advisable to discuss with the doctor before one makes any travel decisions. In addition to the above factors, the doctor will consider the health care facilities at the destination before advising on the benefits and risks of travel as well as recommend any preventive and therapeutic measures.
Not To Travel
Women with certain obstetric and medical risk factors are usually advised not to travel to distant places.
The former includes history of miscarriage, ectopic pregnancy, premature labour, premature rupture of the membranes, high blood pressure or diabetes; history of or existing placental abnormalities; threatened miscarriage or vaginal bleeding in current pregnancy; incompetent cervix; multiple pregnancy and foetal growth abnormalities.
The latter includes history of thrombo-embolism, high blood pressure, diabetes, heart disease, asthma, kidney failure and chronic conditions which require frequent medical care.
A number of issues have to be addressed prior to departure. There should be confirmation that the pregnancy is located inside the uterus and not outside (ectopic pregnancy) as the latter may rupture at any time causing internal bleeding, which is life-threatening.
One should check on the common disease conditions at the destination. This will enable the taking of necessary precautions. One should also check whether the health care facilities at the destination have the capability to deal with obstetric and medical problems.
For example, in the case of a pregnant woman in the third trimester, the health care facilities should be able to manage pregnancy complications including raised blood pressure, bleeding, caesarean sections, and premature or ill babies, and also have safe blood transfusion facilities.
One should discuss with the doctor whether antenatal care will be required during the time that one is travelling, and if so, who would be providing it. It is important that there is no missing of antenatal visits at specific times during the pregnancy.
The safest time to travel is during the second trimester (14 to 28 weeks). During this time, the pregnant woman usually feels her best and the likelihood of spontaneous miscarriage or premature labour is least. It is advisable to refrain from travelling abroad in the third trimester (28 to 40 weeks) because there are issues of access to medical care in the event obstetric or medical problems occur.
It is advisable to travel with a companion who can assist should the need arise. The pregnant woman usually encounters common ailments like nausea and/or vomiting, heartburn, increased frequency of urination, constipation and cramps in the legs. These ailments are no different when travelling.
There are certain signs and symptoms that require immediate medical attention. These are vaginal bleeding, passage of tissue or clots, excessive vomiting, abdominal pain or contractions, rupture of the membranes, headaches, visual problems, excessive leg swelling or pain, diarrhoea, fever and decrease in foetal movements.
As about half of all pregnancies are unplanned, it is essential for women in the reproductive age group, particularly those who are not using any contraception, to ensure that their vaccination status is kept current in the event that there is a need to travel when an unplanned pregnancy occurs.
Advice should be sought from a doctor about the vaccines that are safe when given during pregnancy and those which are not. In general, it is preferable to get vaccinated before getting pregnant as it reduces considerably any risk to the foetus. Women who are given live vaccines (measles, mumps and rubella, yellow fever) should put off pregnancy for a month after receiving the vaccine because there is a theoretical risk of transmission of the virus to the foetus. However, small of studies of inadvertent immunisation of live vaccines to pregnant women did not report a link between the vaccines and poor pregnancy outcomes.
Air travel does not present special risks to a healthy pregnant woman or her foetus. However, it is not advisable for women with obstetric and/or medical risk factors to travel by air to distant places or during the third trimester. It is generally accepted that healthy women with a single pregnancy can travel by air up to 36 weeks. Different airlines have different policies.
Their guidelines permit a pregnant woman to travel by air depending on the previous obstetric history, duration of pregnancy and flying time. One should remember that on the flight home, the pregnancy would have advanced by the duration of the travel.
It is important to remember that the air crew are not midwives and the aeroplane does not have the facilities of a hospital. It would be prudent to check with the airline what is permissible when making the booking reservations. Some airlines require the completion of medical forms by the doctor. Most airlines do not permit their cabin crew and pilots to work on board a flight after 20 weeks of pregnancy.
Prior to boarding an aeroplane, all crew and passengers have to be screened by devices which use radiation, which is minimal. There have been no reports of adverse outcomes for babies born to mothers who were screened. If one is uncomfortable about the screening, one can request a hand search by a female security staff.
As the cabins of all aeroplanes are pressurised with a humidity of about 8%, pregnant women should drink plenty of fluids, especially on long flights, to avoid dehydration. Alcohol consumption is not advisable.
A seat belt has to be worn to prevent accidental trauma. As pregnant women are more prone to collection of blood in the veins of the legs, it is advisable to do exercises that exert a pumping action on the veins. The same would also apply to long road journeys.
The recommended exercises are usually found in the magazines on board the aeroplane. It would also be helpful to move about the cabin as much as possible.
The usual health insurance policies that one has may or may not provide coverage during pregnancy and while abroad. One should check with the insurance company what is covered by the policy. If necessary, a supplementary or travel insurance policy should be obtained for the duration and a day or so prior to and after the travel dates.
The travel policies of different insurance companies vary. In addition, many of such policies do not provide cover for pregnancy-related problems, so it is important to clarify this prior to obtaining the policy. In general, insurance companies do not provide coverage in the last four weeks of pregnancy.
The pregnant traveller should, like all other travellers, be prepared for delays or queues particularly when travelling during festive seasons. The emotional fuse in the pregnant may be shorter than the non-pregnant.
Hence, it is essential to find some means of reducing any stress such as reading a book or listening to music.
Depending on the stage of pregnancy, one may be having morning sickness or is often hungry. Travel may also cause nausea and vomiting. It would be useful to consult the doctor and take some prescribed medicine to consume if there is travel sickness. It is important to take one's meals regularly whether travelling or not. Care must be exercised when eating food outside one's home. Cooked food is less likely to cause gastrointestinal problems than uncooked food.
As it may be difficult to do all the things as one could in the non-pregnant state, it would be helpful to plan out the travel activities. Frequent breaks will ensure that one gets sufficient rest and not get tired. It is important not to take any medicine without consulting a doctor or pharmacist.
More info on PREGNANCY here.
by Dr Milton Lum