 My apologies to our male readers, who I advise to sit back, relax and consider how fortunate you are that none of this information is of any relevance. Unless, of course, your travelling partner happens to be 'with' child, in which case be advised to take this as seriously as her. It's called doing things together, right.
However it has to be said, from my own personal experience, and speaking purely from a professional point of view, more babies are conceived on trips of an adventurous nature than are born.
On a more practical and relevant note, pregnancy is not a disease or an illness. As long as a sensible and responsible attitude is adopted, the adventurous female traveller can still be just that.
Pre-Travel Advice
* Travelling during pregnancy is usually possible, but there are risks, which have to be considered, as no pregnancy can be assured to be trouble free. The potential risks have to be considered, and minimised before any decision to travel is made.
* The following may help you in making that decision, as well as pointing out some of the more salient points to be considered.
* Most airlines will not accept a traveller after 28-32 weeks of pregnancy, some will allow travel up to 36 weeks.
* The most risky times for travel are the first 12 – 15 weeks of pregnancy, when miscarriage is more likely, and after 30 weeks, when complications such as high blood pressure (pre-eclampsia) are more common.
* The best time to travel is between 18-24 weeks, when you probably feel at your best, and are at least danger of experiencing a spontaneous abortion, or premature labour.
* Air travel poses no real risks to a healthy pregnant woman or her baby
* On a commercial jet the cabin pressure is kept at about the equivalent of 6000ft, which should cause no problems.
* Pregnant women and those in the first month after delivery, have a small increased risk of a clot or deep vein thrombosis (DVT).
* To avoid clots, drink plenty of fluids,wear loose fitting clothing, and get up and walk about frequently whilst on the plane. Also stretch your calf muscles and wriggle your toes. Avoid alcohol.
* Repeated long distance flying early on in pregnancy may put you at risk of radiation exposure, and potential harmful effects of your baby, from cosmic radiation, whilst flying at high altitude. Hence avoid repeated, and long distant flights in early pregnancy.
Once you have decided to travel a number of issues need to be considered prior to departure. The pregnant traveller should ensure the following.
* Always seek a medical check up before setting off, and make sure all appropriate test have been carried out I.e. The spina bifida screening at 16-18 weeks. Older women should consider screening for Down's syndrome at 16 weeks. During the first 24 weeks it is common to have an ultrasound scan, to confirm accurately, the age of your baby, and to detect any abnormalities. It's worth arranging your travel around these important dates.
* Determine beforehand whether prenatal care will be required abroad, and if so who will provide it. Take your antenatal card with you, recording previous visits, past obstetric record, and relevant blood tests etc.
* Check the medical facilities at your destination, and if in the last trimester (later pregnancy), the medical facilities should be able to cope with complications like toxaemia, premature labour, and caesarean section, or in earlier pregnancy, the possibility of ectopic pregnancy or miscarriage.
* Determine prior to travelling whether at your destination blood is screened against AIDS, and hepatitis B infection. The pregnant traveller and her companion(s) should also know their blood groups.
* Make sure, before travelling that your travel health insurance covers for pregnancy and a newborn, should delivery take place overseas. Also a supplemental travel insurance covering evacuation should be considered, for certain remote areas, although this may be hard to find. If you are British, and travelling in the European Community, you should obtain the leaflet T6 available from post offices. Within this leaflet is an application form E111, and a list of European and other countries, which have reciprocal arrangements with the UK for free, or reduced cost, medical care.
* Remember it is important to get the 'all clear' from your doctor/specialist before departure.
* It is advisable to travel with a companion(s)
Vaccinations and Malaria advice
Appropriate immunisation and malaria prevention is sometimes different during pregnancy, so seek advice from your doctor. Generally vaccines are only given if the risk of infection is substantial. It is, however, reassuring that there is little convincing evidence, that vaccines given inadvertently during pregnancy, have caused harm to the baby.
* Generally 'live' vaccines should be avoided in pregnancy, and these include vaccinations using oral polio, oral typhoid, yellow fever, mumps, measles, rubella and BCG.
* 'Inactivated' vaccines can be given advisedly, when the threat of disease outweighs any risk from the vaccine. For example, vaccinations against typhoid, diphtheria, hepatitis A, hepatitis B, Meningococcal meningitis and rabies.
* Tetanus and the 'safer' form of polio can be given, if indicated for high-risk areas if not already covered.
* Little is known on the safety of vaccination against Japanese Encephalitis, and it should not be administered during pregnancy, except when you may be staying in a high-risk area. If not mandatory, travel to such areas should be delayed.
* If a yellow fever vaccination certificate is required for your travel, then a letter of exemption may be obtained from your doctor. However if you are pregnant, and you have to travel to a high-risk area, you should be immunised against yellow fever, since the risk of yellow fever outweighs that of the immunisation.
* Malaria in pregnancy carries a significant risk to both you and your baby, and such attacks tend to be much more serious when pregnant. You should ideally avoid malarious areas if possible. If unavoidable the safest antimalarials are chloroquine, and Proguanil, and if the latter is used, take frolic acid supplements. In chloroquine resistant areas, mefloquine may be taken or prevention of malaria in the middle and towards the end of pregnancy. At the beginning of pregnancy, experience suggests no significant increase in congenital abnormalities, but it is best avoided if at all possible.
* Other precautions are advisable such as wearing long sleeves, long pants, shoes and socks, between dusk and dawn. You should also use impregnated mosquito nets, and coils to protect yourself from mosquito bites.
* Doxycycline and malarone should not normally be used.
* Avoid tetracyclines and ciproxin (ciprofloxacin). As a great rule of thumb seek advice before taking any medication, especially in the important first twelve weeks of pregnancy.
General contraindications to International travel
Previous problems in pregnancy
* History of miscarriage and incompetent neck of womb in early pregnancy.
* History of ectopic pregnancy in early pregnancy. It is advisable to rule out another ectopic pregnancy before travelling.
* History of premature labour, or premature rupture of membranes I.e. Waters breaking too early.
* Threatened miscarriage or vaginal bleeding during present pregnancy.
* Twin or multiple pregnancies
* History of toxaemia, high blood pressure or diabetes with any of your pregnancies.
* This being your first baby at 35 years of age, or older, or 15 years or younger.
Pregnant Travellers with General medical risk factors
* Heart problems, affecting the valves in their hearts
* Pregnant ladies with previous history of clots in their legs, or lungs.
* Severe anaemia
* Chronic illnesses that require frequent medical intervention
Areas ideally best avoided unless absolutely necessary
* Those involving high altitudes and scuba diving.
* Areas where there is a high incidence, or an out-break of life threatening food, water or insect – borne infections.
* Areas where there is resistant malaria
* Areas where live vaccines are required.
Travel Advice for the pregnant woman whilst at their destination
* Illness during pregnancy can be more severe, so take care and avoid contaminated food and water, and insect and animal bites.
* Avoid eating food with a high risk of causing food poisoning and Listeriosis, which can affect the growth of your baby and even cause stillbirth I.e. Partially cooked meat, unpasteurised milk products, and soft cheeses.
* The bacteria causing Toxoplasmosis can be found in raw meat, goat's milk and cat faeces, so avoid these potential hazards, which can cause the infection, and foetal abnormalities.
* Avoid close personal contact with locals, in countries where tuberculosis or meningitis are prevalent, as these can be serious during pregnancy, to yourself and your unborn child.
* Motor vehicle accidents are a major cause of injury and loss of life for pregnant women. When available, safety belts should be fastened at the pelvic area. Lap and shoulder restraints are best, and in most accidents, the baby recovers quickly from the safety belt pressure.
* Typical problems of pregnant travellers are the same as those experienced by pregnant non-travellers: fatigue, heartburn, indigestion, constipation, vaginal discharge, leg cramps, increased frequency of urination, and haemorrhoids/piles.
* Signs and symptoms that indicate the need for immediate medical attention are bleeding, passing tissue or clots, abdominal pain or cramps, contractions. Ruptured membranes (waters gone), excessive leg swelling, headaches, or visual disturbance.
* Hepatitis E infection, which is not vaccine preventable, and holds a high complication rate in pregnancy, is best avoided by prevention I.e. Avoiding contaminated water or food.
* Whenever possible drink bottled water, making sure the seal on the bottle is intact.
* Wear loose fitting clothing for overall comfort, and carry anti-fungal creams and thrush treatments, if in a hot climate.
* To avoid feeling sick or faint, carry a light snack such as fruit, biscuits or peanuts.
* Plan to travel at a slower pace, to avoid extra fatigue.
* Be aware that you will need, and want to find toilet facilities much more, whilst you are pregnant, so think ahead.
* If in doubt as to your well being and that of your baby, seek medical advice whenever possible.
Cautions for the pregnant traveller
* Travelling to high altitude will increase your risk of DVT, and put more strain on the cardiovascular system.
* Scuba diving can cause decompression sickness in the foetus, and should therefore be avoided.
* Beware that even if you are a good skier, accidents can happen due to incompetent skiers, which may be hazardous to yourself and the baby.
* Jacuzzis and spas should be avoided, as they are prone to infections hazardous to the foetus.
* Just be sensible. And think for two.
Travellers Diarrhoea during pregnancy
Pregnant travellers should be advised to exercise dietary vigilance while travelling during pregnancy, because dehydration from diarrhoea, and/or vomiting, may lead to dehydration and inadequate blood flow through the placenta (the baby's life line).
* Used bottled water when possible
* Boil potentially contaminated water
* Avoid long term use of iodine-containing purification systems. Iodine tablets can probably be used for travel up to several weeks, but congenital 'goitres' I.e. A swelling in the thyroid of babies, has been reported after long-term use.
* Eat only well cooked meats, and pasteurised dairy products, and avoid pre-prepared salads.
* Do not take antibiotics to prevent traveller's diarrhoea
* Oral hydration with clear fluids is the mainstay of treatment.
* Bismuth and aspirin type medications are contraindicated, because they may cause the baby to bleed, and the bismuth may cause congenital abnormalities.
* Kaolin and pectin may be used.
* Use Immodium/Ioperamide only when absolutely necessary
General advice to the returning pregnant traveller
* Arrange to see your doctor and/or specialist on your return, for an immediate check up on your pregnancy.
* Keep any documentation and records written about your general health, and any obstetric care undertaken whilst travelling or aboard. Make sure these are made available to your specialist.
* Notify your specialist of any illnesses sustained whilst travelling, and any medications used to treat them.
* Inform your specialist if you have needed any blood transfusions whilst away.
* If you develop any 'flu like' illnesses on your return from travelling, or a temperature, visit your own doctor immediately, and tell him/her you have malaria until proved otherwise, especially if you have visited a malarial region, or even passed through such an area.
* Let your specialist know of any incident, or concern you may have for yourself, or your unborn baby whilst abroad or travelling.
* Inform your specialist of any accidents incurred.
* Discuss any psychological concerns you may have.
Finally, travelling during pregnancy is not an immediate contraindicated to travel. With careful advice and planning, most healthy women should enjoy travel.
So get expert advice and reassurance,and if there are no significant contraindications.
Go and Enjoy.
The Travel Health Kit During Pregnancy
Useful things to pack along
* Thermometer, and women in the latter stages of pregnancy, may be advised to carry a blood pressure cuff, and urine dipsticks, so you can check for protein or sugar in the urine, both of which require attention.
* Oral rehydration sachets and multivitamin tablets.
* Antifungal agent for vaginal thrush
* Insect repellent containing a low percentage of DEET and a high factor sun cream.
* Antimalarial and antidiarrhoeal self-treatment medications should be evaluated individually, depending on the traveller, the stage of pregnancy, the itinerary and your health history. Expert medical advice will help you in these decisions.
* Paracetamol is a fairly safe painkiller to take in pregnancy, but avoid aspirin.
* If antibiotics have to be taken Amoxycillin or Erthromycin (if allergic to penicillin) are relatively safe in pregnancy.
* Some antihistamines are safe to take for nasty bites or allergies, but read the labels carefully.
* Constipation is common, especially if your fluid intake is less than it should be. Lactulose is safe, but it is better to increase your fibre and fluid intake.
* As a rule of thumb, most medications should be avoided if possible.
A few useful Websites for women travellers:
www.dfait-maeci.gc.ca
www.journeywoman.com
 |
