A to Z of TRAVEL During Pregnancy

1. A to Z of
TRAVEL
During
Pregnancy
Dr. Jyoti Agarwal
Dr. Sharda Jain

2. Today’s Generation is on
the Move
Today travel for
business & leisure
has increased exponentially
Overseas travel today
has become a
Fashion & Status Symbol

3. • The holidays are a time of great anticipation ,
excitement and lots of joy
• At times can bring stress
Although it is perfectly safe to travel during
pregnancy , one needs to do some extra planning
and take a few additional precautions

4. KEY LEARNING POINTS
• When to travel in pregnancy
• Risk with travelling in
pregnancy
• How to minimize risks
associated with travelling in
pregnancy

5. Mode of travel
• Safe to travel by car, bus, train, plane, or ship
• Motorcycles and scooters are not
recommended

6. When to Travel ??
Most women with healthy pregnancy
can travel safely
ACOG, RCOG 2013
Best time to travel is
between 14 & 28 wks of pregnancy

7. • In the first 12 weeks of Pregnancy, there
is a higher risk of Miscarriage or Ectopic
Pregnancy
• After 28 weeks , biggest issue with
travel is the risk of Preterm Labour
Risk of Travelling

8. ACOG algorithm for travel in pregnancy (2013)
Pregnancy
Travelling not
recommended
Gestation > 28 wksGestation 14 – 28
wks
Gestation <14 wks
Risk of miscarriage or ectopic
pregnancy
Higher risk of delivery
in the aircraft
Travelling
considered safe
Safe to travel
Medical insurance,
vaccination, malaria
prophylaxis

9. When not to travel …..
• Medical risk factors
• Obstetric risk factors
• Travel to Hazardous
destination

10. OBSTETRICAL RISK FACTORS
• History of miscarriage
• Incompetent cervix
• Ectopic pregnancy
• History of preterm labor or PROM
• History of or existing placental abnormalities
• Threatened abortion or vaginal bleeding
• Multiple gestation
• History of toxemia, hypertension, or diabetes
• Primigravida at 35 years of age and older, or 15 years of age and younger

11. Each Indication Is Important
Patients tend to
Repeat their
Performance

12. General Medical Risk Factors
• History of thromboembolic disease
• Pulmonary hypertension
• Severe asthma or other chronic lung disease
• Valvular heart disease ( NYHA class III or IV heart ds )
• Cardiomyopathy
• Hypertension
• Diabetes
• Renal insufficiency
• Severe anemia (Hb < 7.5 gm % ) or haemoglobinopathy ,
sickle cell disease
• Otitis media & recurrent sinusitis

13. Travel NOT advised when planning to travel to
potentially hazardous destinations
• High altitudes (> 12,000 ft )
• Areas endemic for life-threatening food- or
insect-borne infections
• Areas where malaria is endemic
• Areas where live virus vaccines are required
Recent was Zika Virus Alert (WHO)

14. AIR TRAVEL

15. Airline issue guidelines for
pregnant women
• Many airlines do not allow women to fly
after 36 completed weeks of gestation
• Women with multiple pregnancies should not
fly after 33 completed weeks of gestation
Aerospace Medicine Association (USA)

16. CHOICE OF SEAT
• Non- Emergency Exit row seats
• Aisle Seat : To allow free mobility
• Seat belts : Use seat belt constantly while seated
passed between breast and below pelvic bones

17. Cabin Pressure is an issue
with all aircrafts
• Modern aircraft are not pressurized to a sea
level equivalent
• The altitude is between 1524m & 2438 m
• The barometric pressure is significantly
lower than at sea level

18. Reduced Barometric Pressure
In Aircraft Cabin
• Causes reduction in maternal blood oxygen
saturation by upto 10 %
• Compensated by favourable properties of
foetal haemoglobin by
– increasing oxygen carrying affinity
–increasing fetal haematocrit

19. Considerations for air travel
• Low cabin humidity by 10-20% ,
drying effect on airways , cornea &
skin
• Risk of deep vein thrombosis
• Risk of delivery in the aircraft
• Risk of radiation

20. WORLD HEALTH ORGANIZATION
Recent WHO study has described a 2-4 fold
increased risk of thrombosis with air travel
Pregnancy is a thrombogenic state

21. Risk of Deep Venous Thrombosis
• Aircraft seating is cramped
• Passengers tend to remain immobile
• Risk increased by presence of additional risk
factors such as previous DVT or obesity

22. WHO study & Cochrane review
• Risk decreased by regular walks every hour
• Calf exercises while seated
• Use of Graduated Elastic Compression
Stocking would significantly reduce the risk
of asymptomatic DVT

23. RCOG recommends
If the women has additional risk factors
• Previous DVT
• Morbid obesity
• Medical problem - nephrotic syndrome , SLE
Prophylaxis with low molecular weight heparin
should be started from the day of travel to
several days thereafter
Low dose aspirin should not be used in pregnancy for
thrombo prophylaxis associated with air travel

24. RISK OF RADIATION
1) At security check
2) Cosmic radiation

25. X-Ray security devices
• Hand-held metal detectors
• Walk through metal detectors
• Backscatter units
Do not appear to pose hazard to pregnant women
Exposure levels are 10,000 times lower than
mobile phone

26. No information to suggest that a pregnant
women should avoid any security system

28. Risk Of Cosmic Radiation
• Earth's atmosphere absorbs much of the cosmic
radiation
• At high altitudes atmosphere is rarefied, so
radiation levels are greater than at the sea level
• US Department Of Transportation - pilots & aircrew
exposure to cosmic radiation do not indicate
exposure beyond safe limits
• Aerospace Medical Association - expectant
mothers are not at increased risk unless they are
flying several times a week

29. Motion sickness
• Common complaint
• Antihistaminic, cyclizine
antemetic (pyridoxine )
• Eat lightly
• Drink plenty of fluid

30. Long distance travel during Pregnancy
• Gradual adaptation
• Mild tranquilizer
JET LAG

31. Immunizations For Pregnant Travelers
• Vaccinations prior to
departure according to
destination endemic
diseases
• Avoid travelling to
endemic areas of malaria
• Malaria is treated as a
medical emergency in any
pregnant traveler

32. Pregnancy and Vaccination
WHO (2005)
WHO, 2005.
Op Cit

33. Safe vaccines in pregnancy
• Hepatitis B
• Influenza (inactivated )
• Tetanus-diphtheria (Td)
• Tetanus-diphtheria-pertussis (Tdap)
• Hepatitis A

34. No data are available on
safety in pregnancy
• Japanese encephalitis
• Meningococcal meningitis
• Pneumococcal
• Polio,inactivated
• Rabies
• Typhoid (ViPSA)

35. Contraindicated Vaccines
• Tuberculosis (BCG)
• Measles-mumps-rubella
• Human papillomavirus
• Varicella
• Yellow fever
• Typhoid (Ty21a) Live bacterial
• Influenza (live attenuated)

36. Yellow fever vaccine
• live attenuated vaccine
• Contraindicated in pregnancy
• Fetal infection can occur
• Non-immune pregnant women should be
strongly discouraged from travelling to
yellow fever endemic areas

37. Human Normal IG
• Immunoglobulins, If indicated for pre- or post
exposure use can be used with
• No known risk to fetus

38. Malaria Chemoprophylaxis
• Chloroquine (Chlorquin) – category D
Small risk of neurological damage to the foetus during pregnancy. Taken
weekly. Commence 1 week before departure and continue for 4 weeks
after leaving malarial area.
• Mefloquine (Lariam) – category B
Not recommended in 1st trimester, otherwise safe. Taken weekly.
Commence 1-2 weeks before travelling and continue for 4 weeks after
leaving malarial area.
• Proguanil (Paludrine) – category B
Safe during pregnancy. Use only in combination with chloroquine. Folate
supplementation required. Two tablets daily.
• Atovaquone-proguanil combination (Malarone) – category B
Folate supplementation required. Safety in pregnancy has not been
established. 1 tablet daily 1-2 days before entering malarial area and
continuing for seven days after leaving.

39. Reaching Destination

40. Food and Water Safety
“Travellers Diarrohea”
DO’S
• Eat only cooked food
served hot
• Eat fresh fruits and
vegetables only if one can
peel them or wash them in
clean water
• Drink water or energy
drinks that are bottled and
sealed
DONT’S
• Do not eat raw or
undercooked meat or fish
• Do not eat unpasteurized
dairy products
• Do not drink anything with
ice in it—ice may be made
with contaminated water.
Vegetarian diet is most safe for
pregnant woman

41. SEA TRAVEL
• Should be avoided after 28 wks
• Special caution of motion and balance
• Nausea can become worse
• Can lead to decompression illness in the fetus

42. CAR TRAVEL
• Frequent stops needed
• Driving not more than 6 hrs
• Presence of companion
• Seat should be adjusted as far
from the dashboard or
steering wheel as possible
• Seat belt is mandatory
• Air bag instructions to be in
mind in case of accidents

43. JAL Advisory for Pregnant women
As pregnancy is not an illness, air travel does not usually present health
concerns for pregnant women. However, we recommend careful planning in
consideration of your destination and schedule.
Precautions before travel
• Consult your physician in advance to see if it is safe for you to fly.
• Consult with your doctor if you have any symptoms such as bleeding or morning sickness, or if you have any
complications including threatened miscarriage, anemia, or toxemia of pregnancy during pregnancy.
• Reduce stress as much as possible.
• The best time to travel during pregnancy is the stable period between 12 and 28 weeks.
Cases when a medical certificate are required for international routes
When the expected delivery date is in 4 weeks or less (36th week of pregnancy or after)
• When the due date is in 14 days or less, an obstetrician must accompany the expectant mother.
• The number of infant is restricted to one, and he or she needs to have his or her own confirmed seat.
Also a child seat needs to be used for infants' safety.
• When the due date is not certain.
• When multiple births may be expected
• When there were previous premature births
Medical certificates
• The doctor responsible must fill in the due date, whether or not it is safe for the woman to fly, and any
special precautions that should be taken during travel.
• Medical certificates must be completed 7 days or less before departure.

45. Travel if you
Must only

46. Choose safe
mode of
travel

47. Avoid very
long
journeys

48. Schedule
antenatal
visit before
you leave

49. Travel light
Wear loose
clothing
Comfortable
shoes

50. Keep all your medical
records along with
important names and
phone numbers

51. Every situation is
different
Recommendations
should be
individualized

52. Remind the
patient that
these precautions
are not 100%
protective

53. Thumb Rule for both
Domestic & Foreign travels
‘ To Follow your Body’s Signal ’

54. ADDRESS
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Karkari Morh Flyover,
Delhi - 51
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