• Try to arrange your traveling time during your second trimester (14 – 28 weeks of pregnancy) as in the first trimester you may still have morning sickness and later in pregnancy it may cause you to be too tired.

• Plan ahead. Ensure that the journey last less than 5 – 6 hours if possible. Arrange rest stops so you could walk around and do stretches do get the blood circulation going. This is to prevent blood clots forming in your legs. (deep venous thrombosis)

• Wear comfortable shoes and clothes.

• Bring some healthy snacks to munch along the way.

• Bring your antenatal records just in case!

• If you are traveling overseas other considerations:
  • immunizations
  • drink clean preferably boiled or bottled water
  • eat clean food avoid fresh food / vegetable (take those fruit which needs to be peeled e.g banana or orange)
  • Check your medical insurance coverage

• Bring some medication prescribed by your doctor for you for e.g for fever, flu, motion sickness or diarrhea during traveling.

Does pregnancy make me prone to motion sickness?
Yes, it may worsen your symptoms of nausea or vomiting if you already have such symptoms in the first place. To reduce the likelihood of motion sickness in the car, choose to sit in the front seat, open the window for fresh air and focus on the horizon or a distant object.

Is it safe to use a seat belt during pregnancy?
Yes, it is safe to use a seat belt in pregnancy. In fact, it is dangerous not to use one. The seat belt must be properly fastened and the lap belt should be secured below your belly, low and snug on your hipbones. It is important that you DO NOT wear the belt across or above your belly. This is because, should there be a crash, the sudden jolt from a belt in this position could cause the placenta to tear away from the uterus.It is also important to use the shoulder belt, which should fit snugly in between your breasts. Do not place the shoulder belt under your arm or behind your back.

I just found out that I am pregnant, can I travel by air?
Your doctor will not advise you against air travel if you have an uncomplicated pregnancy with no medical or obstetric risk factors for complications. If you are at risk of a miscarriage or an ectopic pregnancy however, such as having a previous ectopic pregnancy or a history of recurrent miscarriages; it would be prudent to confirm the location and the viability of the pregnancy by ultrasound prior to travelling.You should also ensure that you have the appropriate travel insurance that covers your pregnancy and the costs of repatriation in the event of a serious problem.

Can cabin air pressure pose harm to my pregnancy?
All commercial airlines and many non-commercial planes maintain a standard level of cabin air pressure. The air pressure in the cabin is less than at lower altitudes. Therefore, your heart rate and blood pressure will increase to enable you to take in the oxygen that you need. If you are a healthy woman with no serious medical problems, you and your baby should have no trouble in a pressurised cabin. Conversely, if you have severe anemia, sickle cell disease, a history of blood clots, or placental insufficiency, you and your baby may have trouble adapting and should avoid flying.It is also important to avoid unpressurised planes (usually small planes) while you are pregnant. Nevertheless, there are no good data to suggest that commercial airline travel can increase the risks to your pregnancy and delivery such as preterm labour, preterm rupture of the membranes or abruption.

Is it safe to walk through airport screening machines while I’m pregnant?
Most airports require passengers to walk through metal detectors, which use a low-frequency electromagnetic field to look for weapons. At this low level of electromagnetic field, the exposure is considered safe for everyone, including pregnant women.Luggage X-ray machines use X-rays to screen through the luggage. They emit the same kind of radiation as in a dental X-ray and are used only on your bags and other inanimate objects going on the plane.There are now two new types of body scanning machines being used in some international airports. One of them, called the “backscatter” machine, which uses low-level X-rays, has raised some health concerns. The Department of Transport and Health Protection Agency in the UK reports that the total radiation dose from an examination, which may involve two or three scans, is less than that received from two minutes flying at cruising altitude, or from one hour at ground level. With regards to pregnancy, this report notes that negligible radiation doses are absorbed into the body and therefore the does to the foetus is much lower than the dose to a pregnant woman. Thus, it is safe for pregnant women to go through the body scanning machines.

When will the airline restrict me from flying?
The main concern restricting airlines from accepting pregnant women as passengers is related to the risk of labour, which may disrupt or divert the flight and the lack of appropriate care providers and facilities to manage labour or any obstetric complications midflight. Therefore, many airlines do not allow women to fly at the 36^th week of pregnancy onwards. In twin pregnancies or other conditions with a risk of preterm labour, women should not fly after their 32^nd week. Additionally, many airlines will require a letter from a doctor confirming that there are no anticipated complications for flights after the 28^th week of pregnancy and for confirmation of the expected date of delivery

What are the medical conditions which prohibit me from flying?
There are a few medical and surgical conditions which put you at risk while flying. These include :

• severe anaemia with haemoglobin less than 7.5 g/dl
• recent haemorrhage
• otitis media and sinusitis
• serious cardiac or respiratory disease
• recent sickling crisis
• recent gastrointestinal surgery, including laparoscopic surgery, where there have been gastrointestinal procedures carried out and where suture lines on the intestine could come under stress due to the reduction in pressure and gaseous expansion
• a fracture, where significant leg swelling can occur in flight, is particularly hazardous in the first few days of a cast being placed

Can I have vaccination and antimalarial medication before I travel?
It is recommended that you check on the relevant information on vaccines and the need for antimalarial medication for the particular destination. In general, women who are pregnant can use antimalarial agents. Vaccinating pregnant women with inactivated virus vaccines, bacterial vaccines or toxoids is considered safe. Live vaccines, such as yellow fever, should be avoided.

How can I reduce the risk of blood clot formation in the legs & lungs (Deep Vein Thrombosis)?
There are a few simple ways to reduce the risk of blood clot formation in the legs. These are:

• speak to your airline to have an aisle seat to facilitate ease of movement
• take regular walks around the cabin
• carry out in-seat exercises approximately every 30 minutes on a medium or long haul flight
• maintain a good fluid intake and minimize caffeine and alcohol intake to avoid dehydration
• for medium to long haul flights lasting more than four hours, all pregnant women are advised to wear properly fitted graduated elastic compression stockings (up to thigh level).

What should I do if I have other risks for blood clot formation in the legs & lungs?
If you have additional risk factors for thrombosis such as a previous DVT, thrombophilia (such as antiphospholipid syndrome or a heritable thrombophilia), morbid obesity or medical problems such as nephrotic syndrome, speak to your doctor about it. For such women, specific pharmacological prophylaxis with low–molecular–weight heparin (LMWH) may be given to reduce the risk of thrombosis. Aspirin alone is not recommended.

With all these in mind, have a safe journey and enjoy your trip!

References:

• Air Travel and Pregnancy. Scientific Impact Paper No. 1. May 2013. Royal College of Obstetricians & Gynaecologists, UK
• Aerospace Medical Association. Medical Guidelines for Air Travel, 2nd ed. Virginia;AMA:2003.2.
• Magann EF, Chauhan SP, Dahlke JD, McKelvey SS, Watson EM, Morrison JC. Air travel and pregnancy outcomes: a review of pregnancy regulations and outcomes for passengers, flight attendants, and aviators. Obstet Gynecol Sur 2010; 65:396–402.
• Clarke M, Hopewell S, Juszczak E, Eisinga A, Kjeldstrøm M. Compression stockings for preventing deep vein thrombosis in airline passengers. Cochrane Database Syst Rev. 2006;(2):CD004002

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This is an updated article featured in Mummy’s Secret 3 – Your comprehensive guide to a healthy pregnancy.

Written by Dr. Helena Lim Yun-Hsuen, Consultant Obstetrician & Gynaecologist, KL Fertility Centre

Dr. Helena Lim is a Fertility Specialist, Associate Professor& Consultant in Obstetrics & Gynaecology. She qualified as a doctor from Universiti Kebangsaan Malaysia and obtained her specialist degree in the UK in 2006 and completed her master’s degree in Obstetrics & Gynaecology in the same year. Today, she practices at the KL Fertility Centre (also known as Monash IVF) while also lecturing part time at University Tunku Abdul Rahman where she is an Associated Professor.

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