Baby on Board: Tips for the Expectant Voyager

Traveling while pregnant is considered generally safe if the mother-to-be is in good health. But even then, obstetricians and public health officials physicians are quick to offer a long list of caveats and restrictions meant to minimize the dangers to mother and fetus.

The best time to travel during pregnancy is the second trimester, from about 14 to 28 weeks, according to the American College of Obstetricians and Gynecologists. By this time, most women have adjusted to pregnancy and morning sickness has often disappeared.

Travel late in pregnancy is discouraged. “We prefer pregnant patients not to fly after about 30 weeks,” said Dr. Irwin Frankel, a USC clinical professor of obstetrics and gynecology. “I strongly discourage flying after 36 weeks. You really don’t want to go into labor on the plane.” A typical pregnancy lasts about 40 weeks, counting from the first day of the last menstrual period.

If patients must travel late in pregnancy, they should try to get the name of a physician in the destination for emergencies, suggested Dr. Sebastian Faro, professor and chair of the Department of Obstetrics and Gynecology at Rush-Presbyterian St. Luke’s Medical Center, Chicago.

Most airlines have policies to minimize the odds of an on-board birth. Northwest Airlines, for instance, requires women wishing to fly within 30 days of their due date to present a doctor’s statement attesting to their fitness to travel.

What if labor does start on board?

In about 75% of cases, according to Northwest spokeswoman Kathy Peach, a medical professional on board steps forward to help. “We have a phone connection with Mayo Clinic doctors, and we follow their advice about diverting [the flight],” she added.

On British Airways, a pregnant woman who is at 8 1/2 months or beyond needs a doctor’s note to board, said a spokeswoman. On average, two or three births a year occur on the airline, she said.

Even healthy women should avoid travel to developing countries during pregnancy if possible, Faro said, because of the risks of contaminated food and major diseases. “As a rule of thumb, if a patient is pregnant and planning to travel to a country where vaccinations are required, she ought to change her plans,” Faro said. If the trip cannot be postponed, the woman should talk with her physician about the risk of such travel and what to do about vaccinations.

“Weigh the risks and benefits [of vaccines] and avoid the live virus vaccines,” said Dr. David Sack, a researcher at Johns Hopkins University School of Hygiene and Public Health. Yellow fever, for instance, is a live virus vaccine.

“In general, killed vaccines are no problem during pregnancy,” Sack said. Even so, his current trial of an oral vaccine for traveler’s diarrhea, a killed vaccine, excludes pregnant women as subjects for safety’s sake. But if a woman enrolled in his trial for the oral traveler’s diarrhea vaccine and did not know she was pregnant, he said, “there’s no reason to think there would be harm to either fetus or mother.”

According to guidelines from the federal Centers for Disease Control and Prevention, “risk from vaccination during pregnancy is largely theoretical.” Even so, the CDC recommends that the live virus vaccines should generally not be used during pregnancy, but emphasizes that each case must be weighed individually depending on the risk of exposure. Yellow fever vaccine, for instance, should be avoided during pregnancy, according to CDC guidelines, unless yellow fever exposure is unavoidable.

Hepatitis A vaccine is made from a killed virus, but the CDC notes that data on that vaccine’s safety during pregnancy are not yet available, so the decision to take it should be made after weighing risks and benefits. Hepatitis B vaccine, an inactivated virus, can be used during pregnancy, according to the CDC.

Whether travel is by car, train or plane, pregnant women should take a number of other precautions, experts concur:

* Don’t take motion sickness pills without medical advice.

* Don’t lift heavy suitcases.

* Drink plenty of fluids.

* Drive no more than six hours daily, and move around often. If traveling by car, pull off the road every hour and walk around for about 15 minutes. Blood flow to the legs slows during pregnancy; walking will boost circulation.

* In a plane or train, get up and walk up and down the aisle every hour or so for a few minutes.

* Swollen ankles are common, but if the legs are painful or discolored, seek medical attention at the end of the trip.

Women who discover that they are pregnant soon after travel to a developing country or other high-risk locale should be alert for unusual symptoms, such as diarrhea or rashes, and report them to their physicians.

Healthy Traveler appears the second and fourth Sundays of every month.