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Travel in Pregnancy

Travel in Pregnancy. Angela Poole, MD FRCSC September 20, 2013. Objectives. Review risks of travel in pregnancy Health (mom and baby) Financial Be able to appropriately counsel patients requesting travel advice in pregnancy. General Travel Considerations.

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Travel in Pregnancy

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  1. Travel in Pregnancy

    Angela Poole, MD FRCSC September 20, 2013
  2. Objectives Review risks of travel in pregnancy Health (mom and baby) Financial Be able to appropriately counsel patients requesting travel advice in pregnancy
  3. General Travel Considerations Risk of delivery en-route and at destination Singleton pregnancies – limited travel after 37 weeks Multiple pregnancy – no travel after 32 weeks Availability, cost, and quality of health care at destination Check with insurance provider Many will only provide coverage up to 32 weeks May not ever cover medical expenses for the baby Baby may not be able to be repatriated for weeks-months depending on gestational age at birth Not all countries have health care equivalent to Canadian standards
  4. General Travel Considerations Risks of infectious diseases and/or vaccines Areas endemic for malaria Malaria chemoprophylaxis can be safe but best recommendation is to avoid these areas altogether Most vaccines are safe in pregnancy Live attenuated vaccines (rubella, yellowfever) are considered UNSAFE in pregnancy May need to provide documentation regarding reason for not receiving appropriate vaccination
  5. General Travel Considerations Risks to the mom Dehydration Discomfort Edema Venous thromboembolism Risks to the baby No direct risks Consider risks associated with inability to access information – give copies of prenatal records and pertinent results
  6. Travel by Vehicle Generally considered safe Main risk is increased risk of VTE related to prolonged immobility Recommendation: Frequent stops (at least every 2 hours) Give patient a copy of her prenatal records to take with her
  7. Air Travel Cabin Altitude Decreased barometric pressure = decreased oxygen saturation In general, safe for mom No effect on fetus due to fetal hemoglobin having a very high affinity for oxygen Low humidity Not significant enough to cause dehydration Increased ear pain May worsen nausea and vomiting of pregnancy
  8. Air Travel Radiation Body scanners at security SAFE – radiation doses equivalent to 2 minutes of air travel or 10,000x less than a mobile phone In-flight Not significant **No evidence that air travel increases the risk of miscarriage or preterm labor
  9. Air Travel Risk of VTE Pregnancy is a risk factor for VTE Immobility is a risk factor for VTE
  10. Air Travel - Recommendations Check with airline regarding restrictions on gestational ages Check with insurance provider regarding coverage Suggest: Regular walks around the cabin and/or in-seat exercises every 30 minutes Maintain hydration Consider compression stockings (at least 20-30 mmHg) Consider ASA or heparin Provide patient with prenatal records!
  11. Air Travel – When to Avoid First trimester if significant risks of miscarriage or ectopic pregnancy and no previous ultrasound Anytime in pregnancy when significant health problems: Severe anemia (Hb <75g/L) Recent sickle cell crisis Significant cardiac or respiratory disease Otitis media and sinusitis Other reason for increased risk of preterm labor
  12. Summary Generally no travel restrictions in pregnancy Advise proper insurance and checking with airline for travel restrictions Advise ways to prevent VTE Give patient her prenatal sheets and pertinent results

  13. Questions?

  14. References RCOG Scientific Impact Paper No. 1, May 2013, Air Travel and Pregnancy ACOG Committee on Obstetric Practice. ACOG Committee Opinion No 443. Air travel during pregnancy. ObstetGynecol2009;114:954-5.
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