Traveling While Pregnant
By Robert H. Page MD & Curtis P. Page MD
According to the American College of Obstetrics and Gynecology, the safest time for a pregnant woman to travel is during the second trimester (18 to 24 weeks), when there is the least danger of experiencing premature labor. If you are traveling while pregnant, discuss your travel plans and itinerary with your obstetrician prior to travel. Before you leave, have a complete physical with appropriate lab tests to determine the health of the pregnancy. Discuss gestational age, risk of miscarriage, and premature labor with your obstetrician, and make sure all vaccinations are completed prior to travel.
Air Travel During Pregnancy
Air travel is safe for most healthy pregnant women, though each airline has a different restriction or regulation concerning pregnant fliers. (See below for information on contraindications to international travel during pregnancy.) Always consult your obstetrician and your specific airline prior to travel. International travel is usually permitted up to the 32nd week, although it is considered safe to fly up to the 36th week for single fetus pregnancies, 32nd week for twins, and the 20th week for triplets. Always carry a note from your doctor that details your medical history and your expected date of delivery.
A pregnant woman should walk every half hour during a smooth flight, and flex her calf muscles frequently to prevent deep venous thrombosis (DVT). Always fasten your safety belt at the pelvic level below the pregnancy.
Below is a list of possible complications of pregnancy that should be discussed with your obstetrician prior to travel.
Malaria, Pregnancy, and Nursing
Malaria in pregnancy carries significant risk for both the mother and the fetus. Pregnant women are advised to avoid travel to high-risk areas of malaria. Because no anti-malarial agent is 100 percent effective, if a pregnant woman does travel to these areas, she is advised to protect herself against insect bites. Although malaria is considered to be prevalent throughout the Yucatán Peninsula, it is not regarded as a problem in major resort areas such as Cancún, Cozumel, Mérida, and Playa del Carmen. The same cannot be said for more rural destinations and we advise that pregnant women stay within major tourist areas.
Additional guidelines for pregnant or nursing women
Traveler’s Diarrhea (TD) during Pregnancy
If you are considering travel during pregnancy, dietary vigilance is essential. Ingesting foreign bacteria present in food and water is the cause of TD. Thus, be sure to drink only bottled water and eat only well-cooked meats and pasteurized dairy products. Also, avoid raw fruits and vegetables you have not personally peeled and prepared.
Bismuth subsalicylate (Pepto-Bismol) is not recommended during pregnancy because of the possible risks of toxicity to the unborn fetus. If you are pregnant, do not use such absorbed antibiotics to prevent or treat diarrhea. Although not studied for use in pregnancy, Xifaxan (rifaximin) is not absorbed from the intestinal tract and is therefore one antibiotic we consider safe.
If prevention of diarrhea fails, your best bet is to stay hydrated. You may use a combination of kaolin and pectin to slow down bowel function, but use only loperamide (Lomotil) after consulting with a physician. Only consider self-treating TD with antibiotics when there is associated fever or blood in the stool or if the frequency of diarrhea puts mother and/or fetus at risk of dehydration.
The safest effective drug for this form of diarrhea is azithromycin. This is taken in a dose once a day for one to three days. You should maintain adequate hydration by using an oral rehydration solution such as Gatorade, which contains electrolytes that keep cells nourished. If diarrhea is not quickly controlled, seek professional medical attention immediately. See medtogo.com for more information about TD, keeping in mind that treatment guidelines are often altered during pregnancy.
Note: A nursing mother with TD does not have to stop breast-feeding, but she should increase her fluid intake and seek medical attention.
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