Travelling while pregnant

Being "potentially pregnant" isn't at all like those corny old jokes about being "a little bit pregnant". You either are - or you aren't.

Instead, "potential pregnancy" is a real medical risk factor to be considered in holiday planning.

"Male patients who consult me for advice and immunisations before travelling commonly ask about precautions a female travelling companion should take," says Brisbane-based Dr Deborah Mills, spokesperson for the Travel Medicine Alliance, a group of travel medicine clinics.

"They sometimes say 'She's pregnant' but more and more I'm hearing 'She may be pregnant' or 'She may fall pregnant during our trip'.

"I ask them if they're using contraception and, if the answer is 'No', the woman can be considered 'potentially pregnant'," explains Dr Mills, medical director of Dr Deb's - The Travel Doctor clinics.

"It's safest to treat such women as if they're pregnant. I tell the man that, like other travellers, the partner should see a travel doctor before the trip."

Pregnancy shouldn't stop women travelling, says Dr Mills. Most pregnant women enjoy trouble-free flights and holidays.

"But it's never just a matter of flying - it's where women are going," Dr Mills adds. "This is something they should consider, possibly changing holiday destinations." Activities in remote parts of developing countries - trekking in Nepal, for instance - may involve good care being unavailable. Drugs may be inappropriate or out of stock.

"Medical services may not be of the same standard as in Australia. So the woman may want to save the far-flung destination for another time and pick somewhere with more sophisticated levels of care."

What's more, "travel to high-altitude areas isn't recommended for pregnant woman - nor are scuba diving, hot saunas and extreme exertion."

Best time for a holiday? "As a rough rule, the middle third of a pregnancy is the lowest-risk time to travel," Dr Mills advises, agreeing with recommendations given by other travel doctors.

"After the first third, risk of miscarriage is low and morning sickness has usually subsided. (The American College of Obstetricians and Gynaecologists says weeks 18 to 24 are safest.) In the final third, the mother-to-be has a big stomach and may feel more uncomfortable. She may need frequent naps and her feet may swell during air travel."

Many airlines won't carry women beyond their 36th week of pregnancy because of risks of going into labour and in-flight births.

"Travel insurance will usually not cover pregnancy-related problems in the final third of pregnancy," Dr Mills points out. She also recommends travelling with a companion.

Medications and pre-travel immunisations? Some are fine and some aren't. That's why Dr Mills suggests checking with a doctor who is expert in travel medicine.

An example: over-the-counter anti-diarrhoea medications often contain loperamide which may or may not have a low risk for pregnant women. (Risk levels haven't so far been conclusively determined). Consequently, many travel doctors won't recommend loperamide for pregnant women - unless benefits clearly outweigh possible risks.

Malaria dangers may influence the choice of where you'll decide to fly. While some preventative drugs are fine for pregnant women, others are not.

"Pregnant travellers can safely visit many places - but not malaria zones," says Dr Mills. "They're twice as likely as non-pregnant counterparts to be bitten by mosquitoes, due to more heat production and increased release of volatile substances from the skin surface.

"Malaria is more serious in pregnant women - and can lead to miscarriage, stillbirth and even maternal death."

For pregnant women, "all the usual 'travelling well' precautions apply - doubly so," warns Dr Mills - who recommends organising travel so there's adequate "down time" for rest. "Watch out for dehydration," she says. "And fevers increase risk of miscarriage."

The flight itself? "Travel in pressurised aircraft is unlikely to pose a danger," she adds. "But the mother will be at slightly increased risk of deep vein thrombosis (DVT). Book an aisle seat. Go for walks on the aircraft. Wear compression stockings."

Further, since pregnant women are more likely than others to become ill with bladder or respiratory infections, she advocates carrying antibiotics (after checking with a doctor that they are safe in pregnancy).

"Pregnancy makes women hungry," she notes, urging snacks be carried. (Some other doctors say packing health bars and nuts in carry-on luggage is a good idea.) Pregnant women usually feel the need to empty their bladders often. "Dress comfortably - and conveniently for frequent trips to the toilet."

It's easier said than done, but travel doctors recommend pregnant women try to avoid airport stress and not become excited if travel plans go awry for reasons unrelated to their health - and let a companion deal with the issue.

But they don't suggest skipping a holiday just because you're pregnant.