Pregnancy is no longer the barrier to travel it once was, with physicians approving both business and leisure trips if women are healthy, not experiencing a high-risk pregnancy and not in the final stages.
Still, pregnant women should follow certain travel precautions to minimize risks to the unborn baby, experts said. It's also wise to check in advance about any special policies at airlines, cruise ships or tour companies.
Whatever the travel mode, the most comfortable time to go is usually during the second trimester (months four through six), according to the American College of Obstetricians and Gynecologists. That's because the morning sickness and fatigue common in early pregnancy have often subsided.
Flying during pregnancy, except during the last weeks, is generally viewed as safe. Short-term exposure to altitude does not seem to have an undesirable effect on the fetus, according to a study published earlier this year in the American Journal of Obstetrics and Gynecology.
In the study, seven women, all sedentary and in about their 34th week of pregnancy, exercised at sea level and at an altitude of 6,000 feet while investigators evaluated their responses and fetal responses. (Airplane passenger cabins are usually pressurized to an altitude of about 5,000-8,000 feet.)
"The results suggest that pregnant women may engage in at least brief, moderate exercise bouts at moderate altitude without adverse consequences," wrote the study's director, Dr. Raul Artal, professor and chairman of the department of obstetrics and gynecology at the State University of New York, Syracuse. By extension, the study suggests that airplane travel is safe for pregnant women as well, he said.
But flying during the last stages of pregnancy is generally discouraged, Artal and other experts agreed. There is, however, disagreement among doctors about when it is too late to fly.
"We discourage elective travel after 24 weeks," said Dr. T. Murphy Goodwin, USC assistant professor of obstetrics and gynecology and director of maternal-fetal medicine at Good Samaritan Hospital, acknowledging that this view is very conservative and that he makes exceptions for important business or personal travel.
At that point women must weigh the risks, Goodwin said, citing the case of one patient, a businesswoman who delivered twins on the East Coast after flying while 32 weeks pregnant.
No matter how pregnant a woman flier, moving around during a flight is advised. "Walk up and down the aisle to get the circulation going," Artal said.
Agreed Goodwin: "Walk around at least every hour."
Taking a first cruise during pregnancy is not generally advised. But for cruise ship veterans, taking a cruise during the earlier months of pregnancy can be a relaxing way to travel, if motion sickness is not a problem.
At Norwegian Cruise Lines, pregnant passengers in the first through six months are required to bring a "fit to travel" letter from their physician, said Fran Sevcik, a spokeswoman. The cruise line "reserves the right to refuse passage to women in the last trimester of pregnancy," according to company policy.
Carnival Cruise Lines allows healthy pregnant passengers to board until they reach the end of the seventh month, said a spokeswoman. After that, they are declined passage.
Pregnant women traveling by car should be in the car no more than five or six hours per day, according to the American College of Obstetricians and Gynecologists. Safety belts should be used. Contrary to belief, bumpy rides do not induce labor, according to ACOG.
"Stop every hour," Goodwin tells his pregnant patients traveling by car. "Get out and stretch to minimize the risk of blood clots forming."
Certain leisure activities aren't a good idea during pregnancy, Goodwin said. "No scuba diving," he tells his pregnant patients, no matter how early in the pregnancy. "Some research suggests an association between scuba diving and birth defects," he said.
Snorkeling, however, is generally considered acceptable, Goodwin said. Water skiing should be abandoned once a woman begins to show, he said, because at that point the excess weight may affect balance.
Before traveling abroad, pregnant women should find out if there are any vaccinations needed. Such vaccinations are generally discouraged during pregnancy, Goodwin said, but a consultation with a knowledgeable travel medicine specialist is the best idea.
The standard advice during pregnancy is to avoid live virus vaccines. But decisions about vaccinations must be made on an individual basis, weighing the risk of disease at the destination, the mother's health and the risk to the developing infant.
The Healthy Traveler appears the second and fourth week of every month.