Interviewer: Pregnant and traveling? What you need to know, that's next on The Scope.
Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.
Interviewer: Dr. Jennifer Feige is an OB/GYN at University of Utah Health. If you have a patient that's pregnant and thinking about taking a trip or has one scheduled, what kind of advice do you normally give them?
Dr. Feige: I usually break it down into thinking about three different categories. So first of all, when during the pregnancy are they traveling? Where are they traveling to? And then finally how are they arriving at their destination?
To begin with, when we talk about when during the pregnancy is one traveling, while there is no contraindication to travel during any trimester, most commonly if something were to happen during a pregnancy it would occur during the first and/or third trimester. So the ideal time for travel would be during the second trimester, which is between 14 and 28 weeks gestational age. The first trimester carries risks of miscarriage, vaginal bleeding, as well as cramping, and then the third trimester, as you get closer to term, once again, there are increased risks not only with bleeding and/or leakage of fluid but actually going into labor and having a baby. It's always best to be home closer to a hospital and your known OB/GYN as well as with records prior to giving birth on the road.
Interviewer: So you would recommend if you really were concerned, second trimester would be about the best, but as you said before you're all right first or third as well.
Dr. Feige: Exactly. The one contraindication that does come up is some airlines have strict policy of not traveling once you are full term, so after 37 weeks, but otherwise there's no strict contraindication.
Interviewer: And why is that?
Dr. Feige: Once again, just risk of labor when you're in the air -- your water breaking, you're bleeding, you're contracting, and then a baby is born.
Interviewer: Okay, yeah, it's just more of an inconvenience that they would have to deal with that.
Dr. Feige: Yeah, emergency landing of the flight, putting other passengers at risk.
Interviewer: Yeah, sure, okay, fair enough.
Dr. Feige: And maybe not having the team ready to deal with a newborn if for some reason there were another complication.
Interviewer: All right, so that covers the when component. What about the second component which is where?
Dr. Feige: Where, a lot of people these days are more into more exotic travel which is very romantic. We break it down basically into whether you are traveling to a developed country and/or a developing country. Developed country carries fewer risks. Developing does carry more risks because you have to think about where your water is coming from, some preparation of food. But, as long as you're in a developed country there are minimal risks.
The exception to that of course is we've all heard of Zika virus which is within the news, that being in South America, Central America and then parts of North America as well. Zika is an entire separate conversation. But if for some reason you were to travel in areas with Zika we, (a) discourage it in general, (b) if you do opt to go there, use protection. That means covering extremities, sleeping under nets to avoid mosquitoes, using DEET to specifically avoid any bites.
If for some reason you and your partner do travel there and your partner becomes infected, we also encourage condoms times six months because it can be transmitted through sexual intercourse as well. We do offer screening if you were in one of the Zika exposed areas. Here at the University of Utah we can screen for that.
Other contraindications or other things to think about when we talk about developing countries like I alluded to was where the water is coming from. If it is not bottled water, we recommend boiling water for at least a minute prior to consumption. That includes brushing your teeth with bottled water, any type of ingestion at all because water can carry risks of bacteria or viruses. Mainly we think about Hepatitis A when you're traveling to developing countries. Additionally, other things that we talk about is washing your fruits and vegetables, making sure you know how they're prepared, making sure things are well cooked, just once again to decrease your risk of viral or bacteria contamination.
Interviewer: So washing those fruits and vegetables if you're in an area . . .
Dr. Feige: In your clean water with your soap.
Interviewer: Okay, your bottled water.
Dr. Feige: Yes.
Interviewer: Just want to double check that.
Dr. Feige: Not dousing it in the sink. The one other thing we talk about even when you're traveling in developed countries is pasteurization. There is a bacteria called Listeria which even is found here in the United States. You always want to verify that all of your cheeses specifically are pasteurized, not eating deli meats that have been sitting out an extended period of time, or any mayonnaise-type dish that's been on the counter for an extended period of time.
Interviewer: All right, so maybe a trip to France and those exotic cheeses you might want to avoid possibly if they're not pasteurized.
Dr. Feige: Make sure they're pasteurized, exactly.
Interviewer: All right. We've covered the when and the where. The how are you getting there, what are the concerns there?
Dr. Feige: We'll focus on traveling by car, traveling by airplane, and then finally traveling by boat and/or taking that cruise. Really when it comes to car travel there is nothing to be too concerned about. If you obviously are extended period of time, over five hours in the car, if you're making a gas stop we would encourage getting out, stretching those legs and moving around.
It sort of translates into air travel as well. A lot of folks are concerned about DVTs which can be outside of pregnancy, however the physiology during pregnancy increases this risk as well. We usually recommend compression stockings on flights, frequent ambulation, good hydration and wearing loose fitting clothing just to promote general circulation.
Other questions that often come up when we talk about air travel is exposure to radiation. They've done numerous studies on this, and the F.A.A. actually has a tool where you can evaluate your overall exposure to cosmic radiation. Even with the longest flights, they expect that you're only getting about 15% of your max dose. Obviously, airline attendants or people who are frequently in the air would be an outlier here where they could use the F.A.A. tool to be an aid to them.
Finally, the other travel we are talking about is a cruise and/or being on a boat. Things to think about with both travel by water as well as by air is always anti-emetics. Obviously, nausea and vomiting is quite common in early pregnancy. You always want to have your medications with you. Specifically on cruises there has been an association with norovirus which is found on some cruise lines. It causes nausea, vomiting and diarrhea and can be disruptive obviously to a pregnancy and make you feel terrible and can have long lasting effects. If for some reason there were an outbreak on your cruise ship, they would notify you and you would want to definitely let your OB/GYN be aware of that.
Interviewer: Have you ever had any patients that have actually cancelled cruises or . . .
Dr. Feige: Absolutely.
Interviewer: . . . cancelled trips because of a pregnancy?
Dr. Feige: Yeah. That's a pretty common question for us to actually have to fill out a letter saying yes indeed you are pregnant. It happens during ski season quite often as well, needing a letter from us proving that you're pregnant in order to get a reimbursement.
Interviewer: Got you, got you. Any other final thoughts on it? I think you covered very well. It sounds like there are some very practical health concerns. It sounds like there's also some just a lot of comfort concerns as well.
Dr. Feige: Yeah. Once again, overall it's safe to travel during pregnancy. Once you're full term, we encourage you staying close to home, your hospital and your OB/GYN. But otherwise I think it's awesome to get out there and explore.
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updated: May 22, 2019
originally published: June 1, 2017
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