This pamphlet explains

the best time to travel during your pregnancy different kinds of travel and which may be best for you ways to stay healthy when traveling out of the country tips for safe and pleasant travel while you are pregnant

The Best Time to Travel

The best time to travel is probably the middle of your pregnancy—between weeks 14 and 28. Most common pregnancy emergencies usually happen in the first and third trimesters. After 28 weeks, it may be harder for you to move around or sit for a long time. During mid-pregnancy, your energy has returned, morning sickness is gone, and you are still mobile. Paying attention to the way you feel is the best guide for your activities.

Buckling Up It is important to wear your safety belt each and every time you travel in a motor vehicle. Both you and your unborn baby are far more likely to survive a car crash if you are buckled in. When wearing your safety belt, follow these rules: Always wear both the lap and shoulder belt. Buckle the lap belt low on your hip bones, below your belly. Place the shoulder belt off to the side of your belly and across the center of your chest (between your breasts). Never place the shoulder belt under your arm. Make sure the belt fits snugly. The upper part of the belt should cross your shoulders without rubbing against your neck. Do not turn off the air bags. The air bags can help protect you and your baby if you are in an accident. Make sure that the seat is as far away from the dashboard as possible while still being able to easily reach the foot pedals. If you are driving, tilt the steering wheel upward, away from your belly.

Getting There

When choosing your mode of travel, think about how long it will take to get to your destination. The fastest way is often the best. Whether you go by car, airplane, or ship, there are steps you can take to ensure your comfort and safety.

By Car

During a car trip, make each day’s drive brief. Spending hours on the road is tiring even when you are not pregnant. Try to limit driving to no more than 5 or 6 hours each day.

Be sure to wear your seat belt every time you ride in a motor vehicle, even if your car has an air bag (see box “Buckling Up”). If you are involved in a crash—even a minor one—see your health care provider right away. You may need to be monitored to make sure you and your baby are not injured.

Plan to make frequent stops (see box “Deep Vein Thrombosis: Know the Facts”). Use these stops to move around and stretch your legs.

By Airplane

If you have a medical condition that could be made worse by flying or could require emergency medical care, you should avoid flying during your pregnancy.

For healthy pregnant women, air travel is almost always safe during pregnancy. Some domestic airlines restrict travel during the last month of pregnancy or require a medical certificate; others discourage travel after 36 weeks of pregnancy. If you are planning an international flight, the cutoff point for traveling with international airlines is often earlier. Always check with your airline to be sure about their rules when planning your trip.

If you are worried about air pressure and cosmic radiation at high altitudes, these issues normally do not cause problems for occasional travelers. Decreased air pressure during flight may slightly reduce the amount of oxygen in your blood, but your body will naturally adjust. Although radiation exposure increases at higher altitudes, the level of exposure for the occasional traveler usually is not a concern.

Radiation levels may be a concern for pregnant women whose jobs require them to fly often (such as pilots, flight attendants, or air marshals). Frequent fliers may exceed the cosmic radiation exposure limits set by the federal government. Most airlines restrict their flight attendants from flying after 20 weeks of pregnancy. Some prohibit pilots from flying once pregnancy is confirmed. If you are a frequent flyer, be sure to check with your health care provider about how long it is safe to fly during your pregnancy.

When traveling by air, you can take the following steps to help make your trip as comfortable as possible:

• If you can, book an aisle seat, so that it is easy to get up and stretch your legs during a long flight.
• Avoid gas-producing foods and carbonated drinks before your flight. Gas expands in the low air pressure present in airplane cabins and can cause discomfort.
• Wear your seatbelt at all times. Turbulence can occur without warning during air travel. The seatbelt should be belted low on the hipbones, below your belly.
• If you are prone to nausea, your health care provider may be able to prescribe anti-nausea medication.

By Ship

Taking a cruise can be fun, but many travelers on cruise ships have the unpleasant symptoms of seasickness, also called motion sickness. Seasickness is a balance problem. It occurs when conflicting signals about your position from the body, eyes, and inner ear (which controls your sense of balance) are sent to the brain. Seasickness causes nausea and dizziness, and sometimes weakness, headache, and vomiting.

Deep Vein Thrombosis: Know The Facts Deep vein thrombosis (DVT) is a condition in which a blood clot forms in the veins in the legs or other areas of the body. It can lead to a dangerous condition called pulmonary embolism, in which a blood clot travels to the lungs. Research has shown that any type of travel lasting 4 or more hours—whether by car, train, bus, or airplane—doubles the risk of DVT. This suggests that it is not the mode of travel that increases the DVT risk, but the length of time a person remains seated and not moving. Being pregnant is an additional risk factor for DVT. If you are planning a long trip, you should take the following steps to reduce your risk of DVT: Drink lots of fluids. Wear loose-fitting clothing. Walk and stretch at regular intervals (for example, when traveling by car, make frequent stops to allow you to get out and stretch your legs). Special stockings that compress the legs below the knee also can be worn that may help prevent blood clots from forming. However, you should talk to your health care provider first before trying these stockings because some people should not wear them (for example, those with diabetes or circulation problems).

If you have never taken a cruise, planning your first one while you are pregnant may not be a good idea. But, if seasickness usually is not a problem for you, traveling by sea during pregnancy may not upset your stomach. Make sure a doctor or nurse is on board the ship and that your scheduled stops are places with modern medical facilities in case there is an emergency.

It may be a good idea, just in case, to ask your health care provider about which medications are safe for you to carry along to calm seasickness. Seasickness bands are useful for some people, although there is little scientific evidence that they work. These bands use acupressure to help ward off an upset stomach. For many people, seasickness goes away on its own after a few days as the body adjusts to the boat’s motion.

Another concern for cruise ship passengers is norovirus infection. Noroviruses are a group of viruses that can cause severe nausea and vomiting for 1 or 2 days. They are very contagious and can spread rapidly throughout cruise ships. People can become infected by eating food, drinking liquids, or touching surfaces that are contaminated with the virus.

There is no vaccine or drug that prevents this infection, but you can help protect yourself from it by frequently washing your hands and washing any fruits and vegetables before you eat them. If you are pregnant and get this infection (or any other illness that causes diarrhea and vomiting), see a health care provider. Dehydration can lead to certain pregnancy problems. You may need to receive intravenous (IV) fluids.

Before you book a cruise, you may want to check whether your ship has passed a health and safety inspection conducted by the Centers for Disease Control and Prevention (CDC). The CDC performs periodic inspections of cruise ships in order to prevent widespread virus outbreaks. The CDC cruise ship inspection reports can be found at http://www.cdc.gov/nceh/vsp/.

Traveling Outside the United States

If you are planning a trip out of the country, your health care provider can help you decide if travel outside the United States is safe for you and advise you about what steps to take before your trip. The CDC also is a good resource for travel alerts, safety tips, and up-to-date vaccination facts for many countries. The CDC web site has a travel page called “Traveler’s Health” that can be accessed at http://www.cdc.gov/travel/. The CDC can be reached by phone at 1-800-232-4636.

Malaria

One common health concern about traveling in certain areas is malaria. Malaria is a serious disease carried by mosquitoes that presents a major risk to your pregnancy. While you are pregnant, you should not travel to areas where there is risk of malaria, including Africa, Central and South America, and Asia. If travel to these areas cannot be avoided, have your health care provider prescribe an antimalarial drug for you, such as chloroquine or mefloquine. Pregnant women should not take the antimalarial drugs atovaquone and proguanil, doxycycline, or primaquine.

Food Precautions

Traveling to other countries means you may be exposed to other kinds of germs. People who live in the country are used to the organisms in the food and water, but a traveler is not. These organisms can make a traveler very ill.

Traveler’s diarrhea may be a minor problem for someone who is not pregnant. It is a greater concern for pregnant women, though. If you doget diarrhea, drink plenty of fluids to combat dehydration. Before taking a diarrhea treatment, check with a health care provider to make sure it is safe. The best way to prevent illness is to avoid unsafe food and water. Make sure to follow these tips:

• The safest water to drink is tap water that has been boiled for 1 minute (3 minutes at altitudes higher than 6,000 feet). Bottled water is safer than unboiled tap water, but because there are no standards for bottled water, there is no guarantee that it is free of germs that can cause illness. Carbonated beverages and drinks made with boiled water are safe to drink.
• Do not put ice made from unboiled water in your drinks. Do not drink out of glasses that may have been washed in unboiled water.
• Avoid fresh fruits and vegetables unless they have been cooked or if you have peeled them yourself.
• Do not eat raw or undercooked meat or fish.

Tips for the Pregnant Traveler You can help make your trip as comfortable and safe as possible by following these few travel tips: Find out whether your airline or cruise line has any travel restrictions during pregnancy. Have a prenatal checkup before you leave. Take a copy of your health record and your insurance information with you. Keep your travel plans easy to change. Pregnancy problems can come up even before you leave home. Buy travel insurance to cover tickets and deposits that cannot be refunded. Wear comfortable shoes. Wear a few layers of light clothing. Take time to eat regular meals to boost your energy and keep you feeling good. Be sure to get plenty of fiber to ease constipation, a common travel problem. Drink extra fluids. Take some juice or a bottle of water with you. In an airplane, the cabin is very dry. Choose water instead of a soft drink.

Medical Care

Even if you are in perfect health before going on a trip, you never know when an emergency will come up. Be sure to get a copy of your health record to take with you.

If you are traveling in the United States, locate the nearest hospital or medical clinic in the place you are visiting. If you need a doctor, visit the American Medical Association’s web site at http://www.ama-assn.org and search on "Doctor Finder." The American Congress of Obstetricians and Gynecologists’ web site can help you locate an obstetrician. Go to www.acog.org and click on “Find an Ob-Gyn.”

If you are traveling internationally, the International Association for Medical Assistance to Travelers (IAMAT) has a worldwide directory of doctors. To obtain the free directory, call (716) 754-4883, or go to http://www.iamat.org. The doctors in the country you are visiting may not speak English, so bring a dictionary of the language spoken with you. Another tip is to register with an American embassy or consulate after you arrive at your destination. These agencies may be helpful if you need to leave the country because of an emergency.

Finally...

There is no reason to put off taking trips during your pregnancy if you are not having any complications. Letting your health care provider know about your travel plans and staying alert to your body’s signals can help keep you safe while you are away from home.

Glossary

Deep Vein Thrombosis: A condition in which a blood clot forms in veins in the legs or other areas of the body.

This Patient Education Pamphlet was developed by the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women’s health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as “superior.” To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations, taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice, may be appropriate.

Copyright © January 2010 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

ISSN 1074-8601

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