We are all travelling more frequently and to further destinations than even a decade ago. Much of this increase in travel is by air. Long-haul flights and travel to exotic, but under-developed, destinations bring with them important health considerations. Such travel while pregnant needs special consideration. This article addresses some of the most important issues to help you decide where, when and even if you should fly.
Pregnancy is conveniently divided into "trimesters" or three-month periods of time. Each has its own particular issues.
First trimester (0-3 months)
The first few weeks of pregnancy tend to be a mixture of excitement and anxiousness. There is the excitement of the promise of a new child but also anxiety that sometimes things do not work out as hoped. The risk of miscarriage is approximately one in eight, mostly occurring in the first three months of pregnancy. Although flying does not increase that risk it has to be borne in mind when planning travel. It is wise to consider how you might cope should this happen while airborne or at your destination. The longer the flight and the more remote the destination the more you should consider this issue.
Sickness is not uncommon during the first few weeks of pregnancy. This too should be considered before travel for your comfort. Obviously if you have other medical conditions these should be discussed with your doctor.
Second trimester (3-6 months)
The middle three months of pregnancy are considered the safest months to fly. The risks of miscarriage have diminished and complications, such as premature labour, are low. If you have a medical condition or have had pregnancy complications you should discuss these with your doctor.
Third trimester (6-9 months)
From the seventh month of pregnancy onwards the physical burden of carrying the baby increases. The longer the pregnancy continues the higher the chance that labour will occur. For this reason most major airlines will not allow pregnant women to travel after 34 weeks1 (this includes the return flight!). This is because cabin crew are not trained to cope with obstetric emergencies.2 Between 28-36 weeks airlines may allow a woman to fly if she has a doctor's certificate showing that there are no complications and stating the expected delivery date. Complications that would prevent travel include carrying twins or a previous premature labour.
Specific problems associated with air flight during pregnancy
Blood clots: the risk of deep vein thrombosis rises in pregnancy. It is well known that thrombosis is linked to having to remain seated for extended periods of time; for example, as one does on long air journeys or other forms of travel.3 The risk of thrombosis can be reduced quite simply:
- keep well hydrated - take a bottle of water on board with you
- keep your calf muscles moving - this will help blood circulate safely
- use compression stockings. Putting these on before you travel and keeping them on during the flight is thought to be beneficial. (Read the instructions carefully to put them on correctly.)
Using aspirin to prevent blood clots is not usually recommended during pregnancy. If you have already had a thrombosis then the risks are higher of another one occurring during or after air flight. The Royal College of Obstetricians and Gynaecologists 2001 guidelines advise that pregnant women at high risk of thrombosis should be treated with injectable anti-coagulants before travelling by air.4 If you are at high risk of a thrombosis, you will need to arrange treatment with your doctor well before the date that you plan to travel.
Swollen feet: ankle swelling is common in the later months of pregnancy and also follows prolonged sitting. Again keeping your calf muscles pumping and using compression stockings will help. Consider not taking your shoes off during your flight, as you may not get them back on again.
Indigestion: this is common in pregnancy and can become noticeable during air flight. It is best to avoid fizzy drinks and gassy foods in the days before flying. During air flight the cabin pressure drops slightly which will cause gas in the abdomen to expand.
Pregnancy complications: if you have had any problems during this or previous pregnancies you should discuss them with your doctor before travelling. Failure to do so could invalidate your insurance policy if problems arise during travel or at your destination.
Infectious diseases: careful thought must be given to your choice of destination. Of greatest concern is the risk of malaria. Malaria carries significant risks to the mother and baby during pregnancy. There is also the question of anti-malarial drug safety on the developing child. Some countries require certificates of vaccination, which mean having to have live vaccines (for example polio and yellow fever). You and your doctor will need to decide together if the benefits of having these vaccines outweigh the risks for your personal situation. However, it is better to avoid travelling to countries with these diseases if at all possible.
Medical services: although most pregnancies proceed smoothly and have a happy outcome, occasionally problems arise. The prudent traveller will consider these when planning her trip. A miscarriage or premature labour in a remote, poorly served country may have major health implications. If in doubt discuss your destination with your GP. Timing is also an issue: the further on the pregnancy is, the greater the risks.
Babies: air travel during the first two days after birth is not permitted and is inadvisable for the baby's first week of life. This is because the lungs are not mature enough to maintain oxygen levels at the low cabin pressures that occur at high altitude. There are some concerns that air travel during the first six months of life may be linked to sudden infant death syndrome (SIDS), previously known as "cot death", but this hasn't been conclusively proven.2
Air travel during pregnancy needs careful consideration. It is worth considering:
- how important is your journey? Is it vital for work or personal reasons, or is it for recreation?
- what type of flight are you planning? Is it a long-haul or a short-hop flight? (Longer journeys have greater implications during pregnancy)
- what will the medical facilities be like at your destination? Will they be adequate if problems arise with your pregnancy?
- does the country have infectious diseases that require vaccinations? (If so, you will need to discuss the benefits and risks of these vaccinations to yourself and your baby)
- does the country you are going to have reciprocal health agreements with the UK? (If so, you may need form E111, which is available from your local post office - UK)
- if you have to travel by air, the middle three months of pregnancy are the safest and most comfortable ones to fly.