Woman traveling during pregnancy

Woman traveling during pregnancy

When you are pregnant you must take special precautions to protect both yourself and your unborn child from illness when traveling to underdeveloped countries. However, many immunizations and medications routinely recommended for travelers are either unsafe or have not been adequately studied in pregnant women.

Live viral vaccines should be avoided during pregnancy because of the theoretical risk to the developing fetus. These would include measles, mumps, and rubella (MMR) vaccines. Yellow fever and oral polio vaccine can be used if there is a substantial risk of infection but should be delayed until after the first trimester if possible. If the risk of yellow fever is low, but a vaccination certificate is required for entrance into a country, a physician can issue you a waiver letter to excuse you from this requirement.

Live bacterial vaccines, including oral typhoid fever vaccine, have not been studied in pregnant women and their safety is unknown. Tetanus-diphtheria (Td) boosters are generally considered to be safe if needed. Immune [serum] globulin (ISG) can also be safely administered during pregnancy for the prevention of hepatitis A infection.

Malaria infection poses a special risk for the pregnant traveler and may result in a more severe infection and increases the risk of abortion, stillbirth, and prematurity. Chloraquine is a malaria medication that can be safely taken during pregnancy. This medication can protect you against the type of malaria which is found in Mexico, the Dominican Republic, and certain countries in Central America, the Middle East, and Eastern Europe.

However, resistant malaria found in Africa, Asia, South America, the Indian subcontinent, Papua New Guinea, Vanuatu, the Solomon Islands and certain countries in Central America and the Middle East requires the use of mefloquine (Lariam) or doxycycline. Doxycycline should not be taken during pregnancy but the CDC now states that mefloquine can be safely taken during pregnancy. If you plan to take chloraquine in areas with resistant malaria, some physicians recommend the addition of proguanil (Paludrine), which is not available in the US, for some added protection.

Antibiotics such as trimethoprim-sulfa (Bactrim) or ciprofloxacin (Cipro) that are recommended for treatment of travelers diarrhea can also be hazardous to pregnant women and should not be used. Care should also be taken in using any over-the-counter medication, especially those obtained overseas that you may not be familiar with.

Travel during the last six weeks of pregnancy is not recommended and may precipitate labor. Airlines often restrict the boarding privileges of such individuals. Prior to planning a trip abroad, pregnant travelers should first check with their obstetrician to assess their individual risks and determine whether they can travel safely.