According to the American College of Obstetrics and Gynecology, the safest time for a pregnant woman to travel is during the second trimester (18 to 24 weeks), when there is the least danger of experiencing premature labor. If you are traveling while pregnant, discuss your travel plans and itinerary with your obstetrician prior to travel. Before you leave, have a complete physical with appropriate lab tests to determine the health of the pregnancy. Discuss gestational age, risk of miscarriage, and premature labor with your obstetrician, and make sure all vaccinations are completed prior to travel.

Air Travel During Pregnancy

Air travel is safe for most healthy pregnant women, though each airline has a different restriction or regulation concerning pregnant fliers. (See below for information on contraindications to international travel during pregnancy.) Always consult your obstetrician and your specific airline prior to travel. International travel is usually permitted up to the 32nd week, although it is considered safe to fly up to the 36th week for single fetus pregnancies, 32nd week for twins, and the 20th week for triplets. Always carry a note from your doctor that details your medical history and your expected date of delivery.

A pregnant woman should walk every half hour during a smooth flight, and flex her calf muscles frequently to prevent deep venous thrombosis (DVT). Always fasten your safety belt at the pelvic level below the pregnancy.

Below is a list of possible complications of pregnancy that should be discussed with your obstetrician prior to travel:

• History of miscarriage
• Incompetent cervix
• History of ectopic pregnancy
• History of premature labor
History of or existing placental abnormalities
• Vaginal bleeding
• Multiple gestations (twins, triplets, etc.)
• History of toxemia, high blood pressure, or diabetes with any pregnancy
• First-time pregnancy at age 35 or older, or 15 years or younger
• Valve disease of the heart
• Severe anemia
• History of DVT (deep venous thrombosis), pulmonary embolism or active thrombophlebitis (inflammation of the superficial veins of the legs)
• Travel to high altitudes

Note: If you are pregnant and considering travel to a region that is considered high risk for endemic infectious disease, such as malaria or yellow fever, we highly recommend that you postpone your trip until after delivery.

Malaria, Pregnancy, and Nursing

Malaria in pregnancy carries significant risk for both the mother and the fetus. Pregnant women are advised to avoid travel to high-risk areas of malaria. Because no anti-malarial agent is 100 percent effective, if a pregnant woman does travel to these areas, she is advised to protect herself against insect bites. Although malaria is considered to be prevalent throughout the Yucatán Peninsula, it is not regarded as a problem in major destinations such as Cancún, Cozumel, Mérida, and Playa del Carmen. The same cannot be said for more rural destinations and we advise that pregnant women stay within major tourist areas.

Additional guidelines for pregnant or nursing women

• To chase away insects, you may use sprays or coils that contain Permethrin, such as Repel.
• Insect repellents containing N, N-diethylmetatoluamide (DEET) (<35%) are recommended for adults, but pregnant women should use them sparingly because DEET can harm the developing fetus.
• Nursing mothers should carefully wash repellents off their hands and breast skin prior to handling infants.
• Chloroquine has been used for malaria prevention for decades with no documented increase in birth defects.
• Nursing mothers are advised to take the usual adult dose of anti-malarial medication appropriate for the country they will visit. Because the amount of medication in breast milk will not protect the infant from malaria, be sure that your baby has his or her own preventive medications.

Traveler’s Diarrhea (TD) during Pregnancy

If you are considering travel during pregnancy, dietary vigilance is essential. Ingesting foreign bacteria present in food and water is the cause of TD. Thus, be sure to drink only bottled water and eat only well-cooked meats and pasteurized dairy products. Also, avoid raw fruits and vegetables you have not personally peeled and prepared.

Bismuth subsalicylate (Pepto-Bismol) is not recommended during pregnancy because of the possible risks of toxicity to the unborn fetus. If you are pregnant, do not use such absorbed antibiotics to prevent or treat diarrhea. Although not studied for use in pregnancy, Xifaxan (rifaximin) is not absorbed from the intestinal tract and is therefore one antibiotic we consider safe.

If prevention of diarrhea fails, your best bet is to stay hydrated. See Traveler’s Diarrhea to learn oral rehydration guidelines. You may use a combination of kaolin and pectin to slow down bowel function, but use only loperamide (Lomotil) after consulting with a physician. Only consider self-treating TD with antibiotics when there is associated fever or blood in the stool or if the frequency of diarrhea puts mother and/or fetus at risk of dehydration.

The safest effective drug for this form of diarrhea is azithromycin. This is taken in a dose once a day for one to three days. You should maintain adequate hydration by using an oral rehydration solution such as Gatorade, which contains electrolytes that keep cells nourished. If diarrhea is not quickly controlled, seek professional medical attention immediately. See Traveler’s Diarrhea for more information, keeping in mind that treatment guidelines are often altered during pregnancy.

Note: A nursing mother with TD does not have to stop breast-feeding, but she should increase her fluid intake and seek medical attention.