Health and other travel tips 
for new mothers - and soon-to-be mothers 

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When it comes to travel, 
pregnancy is not the end of the road. 
It's the beginning of a new one.

You can have a child, you can be pregnant, you can travel, and be safe. 
Here's how.

>> Make sure health insurance is valid while abroad and during pregnancy. Check to see if the policy covers a newborn should delivery take place. Obtain a supplemental travel insurance policy and a prepaid medical evacuation insurance policy. 

>> Check medical facilities at the destination. For women in the last trimester, medical facilities should be able to manage complications of pregnancy, toxemia, and cesarean sections.

>> Determine beforehand whether prenatal care will be required abroad and, if so, who will provide it. Make sure prenatal visits requiring specific timing are not missed.

>> Check ahead of time whether blood is screened for HIV and hepatitis B at the destination. Pregnant travelers and their companions should know their blood types.

>> Check facilities at the destination for availability of safe food and beverages, including bottled water and pasteurized milk. 

Back to 'what to remember if you go'

(Centers for Disease Control)
 
 

Children and Health

Overall Immunization Schedule for Children
(NOTE: This link requires Adobe Acrobat®)

The U.S. routine schedule for childhood immunizations. This schedule may need to be adjusted if a child is traveling (see documents below).

Vaccination Recommendations for Travelers Under 2 Years Old

NOTE: Children Under 2 Years Of Age May Need To Receive Additional Diphtheria Booster Prior To International Travel

Vaccination Recommendations for Travelers Over 2 Years Old

Food and Water Precautions and Travelers' Diarrhea Prevention

How to protect yourself and your child by taking proper food and water precautions.

Travel Immunizations and Pregnancy

Because of the theoretical risks to the fetus from maternal vaccination, the risks and benefits of each immunization should be carefully reviewed. 

Ideally, all women who are pregnant should be up to date on their routine immunizations. 

In general, pregnant women should avoid live vaccines and women should avoid becoming pregnant within 3 months of having received one; however, no harm to the fetus has been reported from the accidental administration of these vaccines during pregnancy. 
 
 
 

Diphtheria/Tetanus 

The combination diphtheria/tetanus immunization should be given if the traveler has not been immunized in the past 10 years, although preference would be for its administration during the second or third trimesters. 

Measles/Mumps/Rubella 

Immunity to measles is essential for all travelers. Many young adults The specific recommendations for different age groups depend on the traveler’s country of origin, itinerary, and the epidemiology of measles in the country to be visited. 

The measles vaccine as well as the MMR (measles, mumps, and rubella combination) are live-virus vaccines and are contraindicated in pregnancy. 

Because of the increased incidence of measles in children in developing countries, its communicability, and its potential for causing serious consequences in adults, some authorities recommend delaying travel for nonimmune women until after delivery, when immunization can be given safely. 

However, in cases in which the rubella vaccine was accidentally administered, no complications were reported. If a pregnant woman has a documented exposure to measles, immune globulin should be given within a 6-day period to prevent illness. 

Polio 

It is important for the pregnant traveler to be protected against polio. Paralytic disease may occur with greater frequency when infection develops during pregnancy. 

Anoxic fetal damage has also been reported, with up to 50% mortality in neonatal infection. If not previously immunized, a pregnant woman should have at least two doses of vaccine before travel (day 0 and at 1 month). 

Despite being a live-virus vaccine, the oral preparation (OPV) is recommended when immediate protection is needed. 

The recommendation for the nonimmune pregnant traveler is one dose of OPV prior to travel followed by completion of the regimen after delivery. However, for routine boosting or for when immediate protection is not required, the inactivated vaccine (IPV) is preferred. 

There is no convincing evidence of adverse effects of either OPV or IPV in pregnant women or a developing fetus. However, it is prudent to avoid polio vaccination of pregnant women unless immediate protection is needed. In this case, OPV is the vaccine of choice. 

Breast-feeding does not interfere with successful immunization against poliomyelitis with IPV or OPV. IPV may be administered to a child with diarrhea, and OPV may be administered to a child with mild diarrhea. 

Minor upper respiratory illnesses with or without fever, mild to moderate local reactions to a previous dose of vaccine, current antimicrobial therapy, and the convalescent phase of an acute illness are not contraindications for vaccination. 

Hepatitis B 

The hepatitis B vaccine may be administered during pregnancy. For tourists or business travelers, it is not routinely recommended unless the woman will be working in a health care setting, is sexually active with new partners, is planning delivery overseas, or will be a long-term traveler. 

It is desirable, however, for everyone to be protected against hepatitis B. 

Pneumococcal/Influenza

The pneumococcal and influenza vaccines should be given to all who would otherwise qualify for special protection against these diseases: pregnant women with chronic diseases or pulmonary problems. In general, women with serious underlying illnesses should not travel to developing countries when pregnant. 

(Centers for DIsease Control)

Pregnancy

Should you go? Factors to consider 

According to the American College of Obstetricians and Gynecologists, the safest time for a pregnant woman to travel is during the second trimester (18–24 weeks) when she usually feels best and is in least danger of experiencing a spontaneous abortion or premature labor. 

Women in the third trimester (25–36 weeks) may be asked by their physicians to stay within 300 miles of home because of concerns about access to medical care in case of problems such as hypertension, phlebitis, or false or premature labor. The final decision to travel should be based on consultation with the woman’s health care provider. 

If you go - what to remember
 

Once a pregnant woman has decided to travel, a number of issues need clarification prior to departure It is advisable for pregnant women to travel with a companion; in addition, attention to comfort becomes more important. The checklist provides a guideline for planning with regard to medical considerations. 

Motor vehicle accidents are a major cause of morbidity and mortality. When available, seat belts should be fastened at the pelvic area. Lap and shoulder restraints are best; in most accidents, the fetus recovers quickly from the seat belt pressure. However, even after seemingly blunt, mild trauma, a physician should be consulted. 

Typical problems of pregnant travelers are the same as those experienced at home: fatigue, heartburn, indigestion, constipation, vaginal discharge, leg cramps, increased frequency of urination, and hemorrhoids. Signs and symptoms that indicate the need for immediate medical attention are bleeding, passing tissue or clots, abdominal pain or cramps, contractions, ruptured membranes, excessive leg swelling, headaches, or visual problems. 
 
 

• History of miscarriage 
• Incompetent cervix 
• History of ectopic pregnancy (ectopic with present pregnancy should be ruled out prior to travel) 
• History of premature labor or premature rupture of membranes 
• History of or present placental abnormalities 
• Threatened abortion or vaginal bleeding during present pregnancy 
• Multiple gestation (more than one fetus) in present pregnancy 
• History of toxemia, hypertension, or diabetes with any pregnancy 
• History of infertility or difficulty becoming pregnant 
• Primigravida (woman who is pregnant for the first time) older than 35 years or younger than 15 years 

• Valvular heart disease or congestive heart failure 
• History of thromboembolic disease 
• Severe anemia 
• Chronic organ system dysfunction requiring frequent medical interventions 

• High altitudes 
• Areas endemic for or with ongoing outbreaks of life-threatening food- or insect-borne infections 
• Areas where chloroquine-resistant Plasmodium falciparum is endemic 
• Areas where live-virus vaccines are required and recommended 

Breast-Feeding and Travel

If supplementation is considered necessary, powdered formula that requires reconstitution with boiled water should be carried. For short trips, it may be feasible to carry an adequate supply of pre-prepared canned formula. Exclusive breast-feeding relieves concerns about sterilizing bottles and about availability of clean water. 

Nursing women may be immunized for maximum protection, depending on the travel itinerary, but consideration needs to be given to the neonate who cannot be immunized at birth and who would not gain protection against many of these infections (e.g., yellow fever, measles, and meningococcal meningitis) through breast-feeding. 

Neither inactivated nor live-virus vaccines affect the safety of breast-feeding for mothers or infants. Breast-feeding does not adversely affect immunization and is not a contraindication to the administration of any vaccines, including live-virus vaccines, to the breast-feeding woman. 

Although rubella vaccine virus may be transmitted in breast milk, the virus usually does not infect the infant, and if it does, the infection is well tolerated. Breast-fed infants should be vaccinated according to routine recommended schedules. 

Nursing women need to realize that their eating and sleeping patterns, as well as stress, will inevitably affect their milk output. They need to increase their fluid intake, avoid excess alcohol and caffeine, and, as much as possible, avoid exposure to smoke.

Air Travel During Pregnancy

Commercial air travel poses no special risks to a healthy pregnant woman or her fetus. The lowered cabin pressures (kept at the equivalent of 5,000–8,000 feet or 1,524–2,438 meters) affect fetal oxygenation minimally because of the fetal hemoglobin dissociation curve. 

Severe anemia (Hgb 0.5 g/dL), sickle-cell disease or trait, a history of thrombophlebitis, or placental problems are relative contraindications to flying; however, supplemental oxygen may be ordered in advance. 

Each airline has policies regarding pregnancy and flying; it is always safest to check with the airline when booking reservations, as some will require medical forms to be completed. 

Domestic travel is usually permitted until 36 weeks gestation, and international travel may be curtailed after the 32nd week. Pregnant women should always carry documentation stating their expected date of delivery. 

An aisle seat at the bulkhead will provide the most space and comfort, but a seat over the wing in the midplane region will give the smoothest ride. 

A pregnant woman should walk every half hour during a smooth flight and flex and extend the ankles frequently to prevent phlebitis. The seat belt should always be fastened at the pelvic level. Fluids should be taken liberally because of the dehydrating effect of the low humidity in aircraft cabins. 

Women traveling with infants should keep in mind that newborns (younger than 6 weeks old) should not fly because their alveoli are not completely functional. 

Infants are particularly susceptible to pain with eustachian tube collapse during pressure changes, and breast-feeding during ascent and descent relieves this discomfort. 

Additions and substitutions to the usual travel health kit need to be made during pregnancy and nursing:

Talcum powder
Thermometer
Oral rehydration packets
Multivitamins
An antifungal agent for vaginal yeast
Acetaminophen
Insect repellent containing a low percentage of DEET
Sunscreen with a high SPF (sun protection factor)

Women in their third trimester may want to carry:

A blood pressure cuff
Urine dipsticks (to check for proteinuria and glucosuria)
Antimalarial and antidiarrheal self-treatment medications

Most medications should be avoided, if possible. 

(From the Centers for Disease Control and Prevention)
 
 

The FAA strongly recommends the use child safety seats for children under 40 lbs. 

It is important to check with the airline to see if the child seat will fit the width of the airline seat. While airline seats vary in width, a safety seat no wider than 16" in width should fit most coach seats. 

Ask about discount fares for children under two travelling in a safety seat. Purchasing a discounted seat for your child is the only way to guarantee you will beable use a safety seat. 

Ask about the airlines busiest travel times. Avoiding these times make it more likely you will have an empty seat next to you. In many cases, airlines will allow you to place your child infant/toddler in an empty seat next to you. 

Children under 20 lbs should be in a rear-facing seat. From 20-40 lbs use a forward-facing seat. Place the infant seat in the window seat. 

Ask airlines to arrange for assistance in making connections when traveling with children and a child safety seat. 

Infant seats should not be placed in an aisle seat. 

For more information: www.faa.gov/apa/TURB/CRSTips/FRCRS.htm