Gone are the days when even a healthy pregnancy was looked upon as a delicate condition requiring constant bed rest or some measure of confinement. Travel — for work or pleasure — has become a way of life for many women, and it is not often easy or desirable to leave it behind for a full nine months. Many travel clinics report a steady stream of pregnant clients with questions ranging from the safety of weapons-detection devices at airports (specialists agree they are safe) to the treatment of illnesses they might face on the road.
Barring complications like hypertension, a history of miscarriages, diabetes or bleeding — conditions that must be monitored closely — most obstetricians are willing to give a thumbs-up to a sensible travel plan, especially in the second trimester.
But doctors do bring up a number of issues a pregnant traveler should consider in order to ensure a comfortable and safe trip for both herself and her fetus. What follows is by no means an exhaustive summary.
It will come as no surprise to women who have been through pregnancy that doctors identify the second trimester, weeks 14 to 28, as the best time to take a trip. If there are no complications, the risk of pre-term labor is slight and there is generally none of the unwieldiness and exhaustion of the third trimester. Many specialists cite the risk of miscarriage and undiagnosed complications in the first trimester and the possibility of early labor in the third as reasons not to travel far during those periods.
It is a good idea to schedule an examination shortly before departure, and let your doctor know, in detail, your travel plans, so he or she can weigh in with advice. If possible, get a doctor’s referral in the area you are visiting, and make sure you are adequately supplied with prenatal vitamins. For pregnant women traveling long distances, the American College of Obstetricians and Gynecologists suggests carrying a copy of your medical records.
If you are going abroad, assess your health insurance. Will it cover you for prenatal emergencies or delivery in foreign countries? Is there a cut-off date for maternity travel? Many travel-medicine specialists recommend evacuation insurance, particularly for those traveling in remote areas.
If your pregnancy is normal and you are not in your last trimester, air travel, in general, is considered safe, said Rebecca Wolfe-Acosta, executive director of Traveler’s Medical Service of New York. The normal discomforts of flying — dry air, cramped seating — can be even more annoying for pregnant women. Doctors recommend drinking plenty of liquids to keep up the level of placental fluids. Try to get an aisle seat, so you can move around easily. Thromboembolism, or blood-clotting, is a real risk in pregnancy, and you don’t want to stay in a cramped seat for too long. Doctors vary in their recommendations on how often to take a short stroll, from every half hour to every two hours.
Airlines make their own rules for late-term pregnant travelers, so it’s advisable to ask what they are when you make reservations. Even if you’re only in your sixth or seventh month, it’s a good idea to bring due-date documentation in case you encounter suspicious airline personnel.
Car travel can be a good choice for women in the middle months of pregnancy, particularly if they have the time to devise an itinerary that involves no more than six hours of driving a day, with frequent pit stops for stretching and snacking. The College of Obstetricians and Gynecologists, in a pamphlet about travel during pregnancy, emphasizes that a fetus is well cushioned in the uterus and that wearing a seat belt will not harm it.
Richard P. Green, an obstetrician and gynecologist in Washington, said he is leery of women driving long distances in their third trimesters because of sudden tiredness, which can compromise driving abilities.
Swimming, walking — one of the best exercises for pregnant women — and moderately paced hiking at low altitudes are all acceptable activities. But no matter how physically active you are, there are some things you should not do. Scuba diving, for instance, can cause decompression sickness in the fetus. Dr. Michele Barry, professor of medicine and director of the Office of International Health at Yale University, notes that changes in oxygen concentrations at high altitudes can sicken the pregnant hiker and affect blood flow to the fetus. Saunas and hot tubs should be avoided because they raise the core body temperature to unacceptable levels.
“Going to Europe or major cities in the developing world should not be a hazard,” said Martin S. Wolfe, director of the Traveler’s Medical Service of Washington and consultant to the State Department.
One of the first questions a pregnant woman will be asked, said Rebecca Wolfe-Acosta of the Traveler’s Medical Service of New York, is whether such a trip is absolutely necessary.
Malaria, which can cause spontaneous abortion and stillbirth, is a major hazard for pregnant women traveling in many areas of Africa, Asia and Central and South America. Controversy surrounds the use and efficacy of many prophylactics, so if you must travel to a place where malaria is present, seek detailed medical advice before leaving.
For travel to most developing countries, the Centers for Disease Control and Prevention recommends vaccines for a range of diseases. Vaccination is not an issue for pregnant travelers who are up to date with their shots. For those who are not, the risks of vaccination need to be weighed against the risks of contracting the disease. While some shots are considered safe, particularly if administered after the first trimester, others, like the live vaccine for yellow fever, are not. The CDC telephone, 404-332-4559, can provide information about which vaccines are risky.
The same food-safety rules that apply to anyone traveling in developing countries — don’t eat raw fruits or vegetables that can’t be peeled, drink only bottled or purified water — apply even more to pregnant women, because the options for treating traveler’s diarrhea are limited. Pepto-Bismol, for instance, contains aspirin and bismuth, which pregnant women should avoid, and some antibiotics that are often prescribed for severe cases, including tetracycline, may also be harmful. The best treatment is consuming plenty of fluids (oral hydration salts are safe). For travelers and campers not using bottled water, water-purifying products that contain iodine but do not have carbon filters should not be used because the fetal thyroid all too readily absorbs the element.
Pregnant travelers should be especially careful about eating raw or undercooked meat because it may contain organisms that cause toxoplasmosis, a disease that is often without symptoms but can harm a fetus.
Finally, if possible, choose a destination where you’re likely to find food that will satisfy the “pickles and ice cream” syndrome.
For a free pamphlet on pregnancy and travel, send a business-size self-addressed stamped envelope to the American College of Obstetricians and Gynecologists Resource Center-AP055, P.O. Box 96920, Washington D.C. 20090-6920.
