Pregnancy and travel
15.1 Introduction
Medical opinion is often sought as to whether overseas travel is safe during pregnancy, often in the hope of receiving reassurance that the risks are small.
While most pregnant women will enjoy a trouble-free journey, a pregnancy can never be guaranteed to be medically uneventful. Should medical treatment be required, there are likely to be advantages in being at home. Concerns overseas include the availability of medical expertise, possible lack of sterile equipment and blood, the absence of a doctor familiar with the individual history, language difficulties, and cost.
Some infectious diseases (eg malaria - see below) can be more severe during pregnancy and the wisdom of travel to infected areas should be questioned.
15.2 Malaria chemoprophylaxis
Malaria in pregnancy is usually a more severe disease which can result in abortion or stillbirth and complications in the mother.
All pregnant woman travelling to malarious regions should use chemoprophylaxis. Chloroquine and proguanil have a proven safety record in pregnancy. Mefloquine is not routinely used in pregnancy. The product data sheet states that in the absence of clinical experience, prophylactic use during pregnancy should be avoided as a matter of principle. Recent studies suggest that it is safe in the second and third trimesters. So, where a pregnant traveller cannot be dissuaded from visiting areas with a significant risk of highly chloroquine resistant P.falciparum malaria, it can be used cautiously in the second and third trimesters. Ongoing studies suggest it may also be safe in the first trimester. All fertile women using mefloquine should use reliable contraceptives, until three months after the last dose.
As always, chemoprophylactic drugs should be used in combination with measures to reduce mosquito bites. However, DEET-containing repellents should be used sparingly.
15.3 Travel immunisations
All vaccines should be avoided as far as possible in pregnancy because of the theoretical risk of damage to the developing fetus. Published data are generally not available.
For inactivated vaccines, the threat of the disease should be weighed against any risk of the vaccine. If post-exposure rabies immunisation is required, human diploid cell rabies vaccine should be advised.
Live vaccines should especially be avoided if possible. If a yellow fever vaccination certificate is required purely for entry purposes, a certificate of exemption will normally suffice. If the vaccine is inadvertently given to a pregnant woman, she should be reassured that neither yellow fever, nor oral polio or rubella vaccines, have been shown to cause fetal damage. If the danger of infection cannot be avoided, these vaccines could be administered. BCG is similarly best avoided during pregnancy although there is no evidence of harm.
Where the decision has been made to administer a vaccine, it should ideally be delayed until the second or third trimester of pregnancy.
15.4 Flying
Where travel is planned during pregnancy, 18-24 weeks is probably the ideal time. Airlines usually allow travel up to the 36th week, but after the 28th week a doctor's letter may be required stating that the pregnancy is normal, the expected delivery date, and that the doctor is happy for the woman to fly. The policy of individual airlines should be checked.
15.5 Travel medical insurance
Insurance policies should be checked for exclusions.