Travelling may be required during pregnancy for a relaxing holiday or work/ business or personal/ family-related matters.
Is it safe for pregnant women to travel?
Unless there are medical complications, travelling is generally considered safe during pregnancy as long as necessary precautions are taken.
What is the best time to travel for a pregnant woman?
Nausea, vomiting and increased tiredness are common in the first trimester, along with an increased risk of miscarriage (regardless the woman is travelling or not).
On the other hand, the pain and discomfort gradually increase due to the growing fetus.
Moreover, pregnancy complications are generally higher during the first and third trimesters.
Therefore, possibly the best time to travel during pregnancy is between 4-6months (i.e., middle of pregnancy).
Essential things to do before the travel during pregnancy
1. Always book an appointment with the GP or obstetrician to ensure there is no restriction to travel and get the medical ‘fit-to-fly’ certificate if required (especially after 28 weeks of pregnancy for air travel).
2. To explore and find out more information about healthcare facilities at the destination area.
3. Always carry the handheld maternity notes with all relevant clinical information about the pregnancy with scan and blood test results.
Ensure you do not miss any important blood test, scan or appointments while you are away. Please plan ahead and reschedule them appropriately after discussing them with healthcare providers.
4. Check the details of travel insurance to ensure all relevant pregnancy-related medical care.
5. Find out detailed information about the current health (disease outbreaks), climate (eg flooding) and political situation (ongoing conflict or war zone) of the destination and place of stay.
6. To take all necessary medications such as prenatal vitamins or common over-the-counter drugs (such as paracetamol)
7. To confirm that if any travel vaccination is required.
8. It is preferable to have flexibility in the travel plans, in case of a pregnancy-related event.
9. Please check the label and ensure sunscreen and mosquito repellant products are safe to be used during pregnancy
When it is advisable not to travel?
1. High risk of miscarriage or preterm labour
2. Vaginal bleeding (recent or ongoing)
4. Rupture of membrane
5. Any other medical complication where obstetrician has advised against travel.
7. Severe diarrhoea and vomiting.
How to prevent a deep vein thrombosis (DVT)?
DVT is a condition where a blood clot develops within a vein situated deep inside the body. A common site of blood clot formation is the deep veins in the legs.
Once formed, the blood clot can travel the bloodstream to block the blood vessels of the lungs (called pulmonary embolism). Sometimes, DVT can be fatal and is one of the leading causes of death of women during pregnancy and post-childbirth period.
Pregnancy is a risk factor for DVT. The risk rises when the pregnant woman is sitting for a long time without moving the legs, such as long-distance (over 4 hours) flights or car trips.
The common symptoms of leg DVT are a pain, swelling, redness and discolouration (bluish or whitish) of the legs (commonly starts in calf muscles). Increasing shortness of breath and sudden chest discomfort or pain could be symptoms of pulmonary embolism.
Please seek medical advice at the earliest if you develop the above symptoms after long-distance travel during pregnancy and postpartum.
Preventative measures for DVT:
1. To stay hydrated: drink plenty of water.
2. To move around on a regular basis. For example, preferably every 2 hours in the flights and regular stops during driving to walk around and stretch the legs.
3. To do in-seat exercise (at least every 30 minutes) both during long-journeys by air and car (if not driving). This involves wriggling the toes and flexing and rotating the feet.
4. To wear appropriately fitted graduated compression/ support stocking. This will also prevent leg swelling (‘oedema’).
5. A short course of aspirin or a blood-thinning injection may be required during the travel period if you are at high risk of developing the blood clot. This will be decided by the obstetrician.
6. To wear loose clothing and comfortable shoes.
In a trip abroad during pregnancy, securing good travel insurance is a must. Events during pregnancy can suddenly change without warning. Therefore, travel insurance is important to ensure the pregnant woman is covered for eventualities.
Please read the terms and conditions of the travel insurance policy document in detail (including the exclusions written in small prints).
As pregnancy is not a medical condition, as a general rule, no extra payment is required for the travel insurance. However, the following needs careful consideration:
Usually, travel insurance only covers for medical complications related to pregnancy and childbirth. It does not cover for normal childbirth or treatment of routine ailments.
There can be restrictions on the cover for the complications in relation to preterm birth. Usually, the cover is provided to preterm births within the first 32 weeks of pregnancy and not afterwards.
It is safe to have non-live vaccines during pregnancy. However, live vaccines are not recommended for pregnant women except yellow fever vaccine (as the benefits outweigh the risks of the disease).
Some anti-malarial tablets are not recommended during pregnancy. Therefore, discuss this with your GP or healthcare provider to have a safe alternative.
It is advisable for pregnant women to avoid travelling to Zika virus and malaria-endemic areas. These illnesses are spread by mosquitoes.
Up-to-date information regarding the Zika virus situation globally could be found here.
FLYING: good practice tips
1. Always check the airlines’ policy for travel during pregnancy.
Usually, the airlines won’t allow pregnant women to travel:
a) after 37 weeks if singleton pregnancy
b) after 32 weeks if carrying multiple pregnancies (twin or triplets)
In certain international flights, the travel restrictions can be earlier.
2. Most of the airlines will require a ‘fit-to-fly’ certificate for air travel after 28 weeks of pregnancy. This is to ensure the pregnant woman is not at risk of developing complications.
3. To book an aisle seat if available. This would help to get out and take a regular walk without causing inconvenience to the others.
4. It is preferable to avoid taking large amounts of fizzy carbonated or caffeinated drinks.
Carbonated drinks can make the bloating sensation worse and can cause discomfort.
Moreover, daily caffeine intake should be restricted to 200 mg.
5. It is safe to avoid consuming alcohol during pregnancy.
6. Always take measures to prevent DVT (as discussed above) in long-haul flights.
CAR TRAVEL: good practice tips
1. Prevent accidents
Road traffic accidents are one of the common causes of bodily injury during pregnancy.
a) Tiredness and dizziness are common symptoms during pregnancy.
Stop and take a break when you feel tired and exhausted.
b) Travel with another adult especially during long journeys. You may request your companion to drive if needed.
c) Stay hydrated and have healthy snacks (when not driving).
d) Always wear the seat belt and position this properly: The shoulder belt should be placed between breasts and by the side of the abdomen.
2. Prevent blood clots and swelling of legs:
a) Avoid long car journeys (more than 4 hours) whenever possible.
b) To stop on a regular basis to move around and stretch the legs.
c) When not driving, it is preferable to do in-seat exercises.
d) To wear compression/ support stockings.
FERRY: good practice tips
1. Please read the ferry company’s policy before making travel plans. Many companies restrict travel after 32 weeks of pregnancy.
2. Ensure the availability of on-board medical facilities on longer journeys (such as cruises). Also, find out the itinerary of the cruises to ensure medical services at the scheduled stops.
3. Seasickness can make nausea and vomiting worse.
4. Good hand hygiene is vital to prevent norovirus infection. This can cause severe food poisoning.
FOOD & DRINK SAFETY
There is a potential risk of getting foodborne infections after consuming contaminated food and drinks.
Therefore, good hand hygiene and careful selection of dishes (especially, to avoid raw and undercooked food) are very important.
Avoid drinking alcohol during pregnancy as there is no known safe lower limit during this period.
Care to be taken while drinking the local water, especially directly from the tap. Please check the local health safety guidance and drink bottled water if not sure.
Contaminated water is a common cause of infectious disease outbreaks such as hepatitis A.
When to seek urgent medical advice during travelling?
1. You should get emergency medical advice f you develop any of the following symptoms:
2. Abdominal pain or contractions
3. Bleeding from the vagina
4. Leaking of water from the vagina (rupture of membranes)
5. Persistent headache, disturbance of vision or severe pain in the upper part of the abdomen. These are maybe symptoms of severe preeclampsia.
6. Fever, rash or feeling very unwell.
7. Severe nausea, vomiting and/ or diarrhoea.
8. Symptoms of DVT or pulmonary embolism (as discussed above).