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Travel and Vaccination
Main and The Obgyn Clinic of Hvidovre (danish)
Most foreign airlines do not allow pregnant women to travel after 35 weeks' gestation; for domestic airlines the limit is 36 weeks. Changes in clotting factors and venous dilation during pregnancy put pregnant travelers at risk for superficial and deep thromphlebitis, especially on long flights. Frequent walks around the cabin and stretching exercises may help. Pregnant women should also drink large amounts of non-alcoholic beverages to compensate for water loss due to the extremely low humidity of pressurized flights. Sitting for prolonged periods in a car can also increase the risk of thromboembolism in a pregnant woman; car travel should be limited to a maximum of 6 hours per day. Sea travel can exacerbate the nausea and vomiting associated with pregnancy, particularly in the first trimester. Most cruise lines will carry pregnant women up to the seventh month. High Altitude Pregnant women should avoid altitudes > 4,000 meters (13,123 feet). In late stage or high risk pregnancy, altitudes of > 2,500 meters (8,200 feet) should be avoided. Prevention of Malaria: Pregnancy is associated with increased susceptibility to malaria. If possible, stays in high risk areas should be avoided. If chemoprophylaxis is necessary and the region(s) visited do not report chloroquine resistance, chloroquine is and safe throughout pregnancy. For unavoidable travel to countries appropriate reporting chloroquine resistance, mefloquine (Lariam) is considered safe during the second and third trimesters of pregnancy and the early postpartum period. Traveler's Diarrhea: Pregnant women should follow strict food and water precautions. They may have an increased risk for traveler's diarrhea due to decreased gastric acidity and increased transit time of food through the intestine. Fluid loss can lead to premature labour and shock. Antimicrobial prophylaxis is not generally recommended for pregnant women. Bismuth subsalicylate (Pepto-Bismol) is contraindicated due to the risk of fetal bleeding and teratogenicity. For treatment, oral rehydration should be used for diarrhea only when necessary. If an antibiotic is needed for treatment of invasive diarrhea, azithromycin 1000 mg as a single dose or 500 mg daily for 3 days can be used. Fluoroquinolones are contraindicated in pregnancy. Vaccinations During Pregnancy Cholera Inactivated bacterial Data on safety in pregnancy are not available Should weigh the theoretical risk of vaccination against the risk of disease. Hepatitis A Inactivate Virus Data on safety in pregnancy are not available. Should weight the theoretical risk of vaccination against the risk of disease. Consider immune globulin rather than vaccine. Hepatitis B Recombinant or plasma-derived Recommended for women at risk of infection. Immune globulins, pooled or hyperimmune Immune globulin or specific globulin preparations Administer, if indicated Influenza Inactivated whole virus or subunit Recommended for women after the first trimester if in an at-risk area Japanese encephalitis Inactivated virus Data on safety in pregnancy are not available Should weight the theoretical risk of vaccination against the risk of disease Measles Live-attenuated virus Contraindicated Meningococcal meningitis Polysaccharide Administer if indicated Mumps Live-attenuated virus Contraindicated Plague Inactivated bacterial Data on safety in pregnancy are not available. Should weigh the theoretical risk of vaccination against the risk of disease. Pneumococcal Polysaccharide Administer if indicated Polio, inactivated Inactivated virus Administer if indicated Rabies Inactivated virus Administer if indicated Rubella Live-attenuated virus Contraindicated Tetanus-diphtheria Toxoid Administer if indicated Thyphoid Inactivated bacterial (Vi polysaccharide) Data on safety in pregnancy are not available, but administer if indicated. Should weigh the theoretical risk of vaccination against the risk of disease. Typhoid (Ty21a) Live bacterial (oral vaccine) Data on safety in pregnancy are not available, but not absolutely contraindicated. Should weigh the theoretical risk of vaccination against the risk of disease. Varicella Live-attenuated virus Administer if indicated because of unavoidable exposure. Reference: (1) CDC recommendations from Health Information for International Travel 2003. (2) ACOG Committee Opinion. Immunization during pregnancy. Intl J of Gynecology & Obstetrics 81 (2003) 123-128. (3) ACOG Committee Opinion. Inf J Gynecol Obstet 2002;76:338-39 Se also: Centers for Disease Control and Prevention (USA)
Feel free to mail me or the webmaster Dr Lars Krag Moeller if you have suggestions or corrections that you believe could improve the manual. (niels.secher@hvh.regionh.dk) |