Pregnancy

Question 1

Pre-travel preparation?

Answer 1

• Advise do not travel to malarious areas, if pregnancy complications or if no access to medical care
• Ensure travel insurance is aware of pregnancy and covers care for baby and carry emergency contact number
• Early pregnancy scan should be performed prior to travel to establish gestation and viability
• Seek out where medical care would be available and if none, emergency plans made prior to travel
• Carry antenatal records

Question 2

What gestation can a pregnant patient fly until?

Answer 2

Most airlines is 36 weeks for uncomplicated pregnancy and 32 weeks for a multiple pregnancy. Most airlines will request a certificate after 28 weeks stating EDC and that there are no complications (also consider date of return journey)

Question 3

Are there any restrictions for cruises?

Answer 3

May decline to take travellers in mid to later stages of pregnancy. Travellers should check with the cruise line.

Question 4

Health advice during travel?

Answer 4

• DVT prevention - over 4 hours (includes properly fitted graduated compression stockings providing 15-30mmHg pressure at the ankle)
  (if additional risk factors may need clexane)
• Malaria prevention, Zika risk - consider postponing
  (NB if cannot all precautions - ideally stay indoors between dusk and dawn); also dengue and chikungunya
• Gastro prevention: very careful with listeria precautions and gastro precautions (gastro can affect mother and foetus) - seek prompt medical attention if signs of dehydration, diarrhoea prolonged or fever/blood/mucous

Question 5

Loperamide in pregnancy?

Answer 5

No

Question 6

DEET in pregnancy?

Answer 6

Yes - up to 50% but avoid excessive application (wash off when returning to airconditioned accommodation or sleeping under insecticide treated net)

Question 7

What is the risk around malaria in pregnancy?

Answer 7

• Mosquitoes attracted to pregnant women
• Increases risk to foetus: stillbirth, miscarriage, low birth weight
• Increases risk to mother: severe malaria resulting in death
• Harder to diagnose: parasites sequestrate in placenta

Question 8

Antimalarials in pregnancy?

Answer 8

• Mefloquine: 2nd and 3rd trimesters, with caution in 1st trimester if risk is high (e.g. Africa)
• Doxycycline: contraindicated, may in special circumstances be used up to 15 weeks (including 4 weeks post) where other options are unsuitable
• AP: safety has not been established in pregnancy, generally not advised due to sparse data however no problems with individual components, therefore can be used after careful risk assessment in 2nd and 3rd trimesters

Question 9

Altitude during pregnancy?

Answer 9

Lack of evidence
First trimester - avoid (especially until first scan done to confirm viability of foetus)
After 20 weeks - short stays (hours to days, without heavy exercise) in altitudes up to 2500m in uncomplicated pregnancies thought to pose minimal risk
Travel to sleeping altitudes of 3000m or to remote areas is not advisable during pregnancy
If any complications (incl HTN, anaemia etc), avoid
Do not use acetazolamide