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Air Travel & Immunisation |
Latest advise from the BMJ on travelling in pregnancy (PDF)
Latest advice from RCOG (PDF)
I’m commonly asked about travelling and going on Holiday when Pregnant. Below you will find some general guideline.
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. Do you really have to go?
Malaria Prevention
Malaria in pregnancy can result in miscarriage, preterm labour, stillbirth and severe complications in the mother.
All pregnant woman travelling to malaria regions should use chemoprophylaxis. Chloroquine and proguanil have a proven safety record in pregnancy. Mefloquine is not routinely used in pregnancy though 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, these drug should be used in combination with measures to reduce mosquito bites. However, DEET-containing repellents should be used sparingly.
Travel immunisations & Vaccinations
All vaccines should be avoided as far as possible in pregnancy because of the theoretical risk of damage to the developing fetus.
Inactivated vaccines can be used with caution and 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.
Flying
Air Travel per say doesn’t affect the Baby in utero but it is what happens during the flight and at your destination that need to be considered
Where travel is planned during pregnancy, 18-24 weeks is probably the ideal time. Airlines usually allow travel up to the 36th week, but each airline is different and it depends if you are doing a short domestic flight or a longer international flight
Usually 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.
NB Individual airline policies should be checked and remember to also look at the return dates
DVT Deep Venous Thrombosis
Clots in your legs is more common in Pregnancy and also when flying – so it is vital that you
1. Wear Travel compression socks
2. Move about the Cabin frequently
3. Stay Hydrated with lots of water ( this will also ensure mobility as you run to the toilet more often!)
4. Aspirin tablets are not recommended
Travel / medical insurance
Most Travel Insurance policies will cover a normal pregnancy but it is wise to make a courtesy call to them before you leave and check they are happy. An unscheduled visit to an OBGYN in Florida could be very expensive!
Foreign Travel with a new Baby / Breastfeeding
A newborn can fly at a week old if it's absolutely necessary, but it's better to wait until the baby is at least four to six weeks if you can. By then you will know whether or not he has any underlying health problems which may make it unsafe for him to travel.
Also, babies are very vulnerable to infection during their first month and no matter how careful you are they could pick up a stray bugs from the thousand of contacts you will have in the airport and then the hundreds of strangers breathing recycled air for hours on the flight.
Airlines generally will not take infants under 48-hours-old, but some may take babies up to a week old, providing you can supply them with a doctor's note stating baby is fit to fly.
Mothers who have given birth within the last 48 hours are also unable to fly.
A mother who has had a Caesarean section is unable to fly until at least 10 days after the birth.
Airline officials explain that the reasons for these rules are that medical risks, such as bleeding, blood clots are just too high in the first few days
Passports
NB Remember all Babies must have their own passport as it is no longer possible to travel on their parents.
VACCINATIONS
If you are going to travel with a newborn then the normal vaccination programme may need to be adjusted
See http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=children&obj=child-vax.htm&cssNav=browseoyb#tab8-2
Babies in the UK are routinely given vaccinations against diphtheria, polio (orally), tetanus, meningitis (Hib) and, if parents request, tuberculosis (TB).
Doctors advise parents to think twice before travelling to places where their child may be put at risk of more exotic diseases. Babies under six-months cannot be given yellow fever injections because they are at risk of contracting encephalitis.
The Centres for Disease Control and Prevention is an excellent up to date resource for Travelling when Pregnant or breast feeding and preparing to travel with a new baby
http://www.cdc.gov/travel/vaccinat.htm
Always carry a copy of your Childs personnel Health Record (the red book) with you at all times preferably in your hand luggage, as cases sometimes get misplaced.
Babies under two-months old cannot take anti-malarial tablets. Doctors also advise strongly against travelling to malaria-infested areas unless it is absolutely necessary for any Infant.
Protection should also include using mosquito repellent on your child and their clothing. As well as a mosquito net for your child’s cot it is advisable to use one to cover there buggy/pushchair particularly in the evening. Mosquitoes can bite through thin cotton clothing, so covering up alone is inadequate. A repellent that does not contain deet is better for young skin, try to get one containing a natural ingredient such as citronella oil.
Always take out comprehensive travel insurance for all of your family.
Lots of Good tips and practical advice can be found at Babies First Flight (http://www.babies1stflight.co.uk/)
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©2003 - 2011 Dr Paul Fogarty