AIR TRAVEL AND PREGNANCY (1)

 WHAT ARE THE RISKS?

Dr. Claude Allouche, Obstetrician Gynecologist
Ahuza Clinic, Raanana, Israel
058 726 02 64

WHAT ARE THE RISKS?

As I constantly say, pregnancy is not a disease, and it is entirely possible to travel by plane when pregnancy is progressing normally, provided certain conditions are met.

According to the Royal College of Obstetricians & Gynaecologists:

• If it is an uncomplicated pregnancy and the expectant mother is in good health, changes in atmospheric pressure or a decrease in humidity have no impact on the mother and her baby.
• A flight by plane cannot cause a miscarriage, premature birth, or rupture of membranes.
• Anyone taking a flight is exposed to a low level of radiation, but occasional flights are not considered a risk for the mother and her baby.

Regarding the safest period of pregnancy to take a flight, the College issues the following recommendations:

• Before 37 weeks for a single pregnancy. After this deadline, labor can start at any time, so it is recommended to avoid taking a flight.
• Before 32 weeks for an uncomplicated twin pregnancy.

However, it is not recommended for pregnant women to take a flight in the following cases:

• Increased risk of premature birth or spontaneous miscarriage
• Severe anemia
• Recent sickle cell crisis
• Recent vaginal bleeding, suspicion of ectopic pregnancy
• Lung or heart disease affecting breathing

In all cases, it is advisable to seek advice from your obstetrician before considering a flight.

The Risk of Thrombotic Disease During Air Travel

Venous thrombosis results from the formation of a blood clot in the legs or pelvis. This clot can travel to the lungs and cause a pulmonary embolism.

Long flights by plane pose a risk of developing thrombotic disease due to three mechanisms:

• Leg immobility
• Dehydration
• So-called hypobaric atmosphere (reduced atmospheric pressure)

Blood circulation slows down when you don't move, and the risk of phlebitis increases.

Pregnancy constitutes an added risk due to different factors:

• Venous stasis
• Compression by the gravid uterus
• Hypercoagulability

This risk increases with the duration of the flight and in the presence of risk factors such as a history of thrombosis or being overweight.

Therefore, in its recommendations for travelers in 2014, the National Institute for Public Health Surveillance (INVS)calls for increased vigilance in pregnant women during air travel and recommends seeking advice from an obstetrician before departure. An anticoagulant injection may be recommended for pregnant women who have a history of phlebitis.

TIPS BEFORE BOOKING YOUR TICKET

- At the time of booking, remember to ask the travel agent until what term the airline allows you to fly and also think about the date of return!

Each airline has its own pregnancy policy: some require a medical certificate indicating the term of the pregnancy and the absence of pregnancy-related pathology. Consider asking your doctor.
Most of them refuse to take you on board after 7 months of pregnancy.

Before buying a ticket, it is therefore important to inform the airline of your pregnancy, if only to board in priority and benefit from an aisle seat.

- Remember to take out cancellation insurance. In the event of a last-minute contraindication to taking the plane, you could be reimbursed.

- Check the terms of your travel insurance contract. In the event of a long-haul flight, check that it accepts the repatriation clauses.

- Choose the right destination during pregnancy!

In the event of a distant destination, check with your doctor about the need for vaccination. Some vaccines are contraindicated or not recommended for pregnant women. Similarly, some infectious diseases are more serious in pregnant women or dangerous for the fetus, such as Malaria. It is preferable to avoid countries where resistance to antimalarial treatments is high (Brazil, Guyana, Cameroon, etc.)
- Find out about the level of medicalization in the country (a small health concern is always possible)

- A consultation before departure

Keep your gynecologist informed of your project and do not arrive in his office with your train or plane tickets in your pocket.
Indeed, he might think that it is better to give up your vacation.
This is particularly the case if you have already given birth very prematurely or if the fetus is suffering from growth retardation, which requires regular monitoring in the hospital.
Your doctor will also make sure that the cervix is ​​closed properly and that there are no abnormal contractions.

- Your first aid kit

A minimum of medication is required depending on the destination.
Ask your doctor to prescribe
   * broad-spectrum antibiotics,
   * mosquito repellent
    * an antidiarrheal based on Loperamide. If diarrhea and fever persist beyond 24 hours, consult because they can trigger contractions and premature delivery.
Precautions to be taken to avoid diarrhea are:
   * drink bottled water,
   * do not add ice cubes,
   * give up raw vegetables and undercooked meats and fish.

TIPS DURING THE FLIGHT

Your place is reserved, all you have to do is think about the last minute details.

To limit the risk of occurrence of venous thrombosis during the flight, it is advisable to:

-Wear loose cotton clothes that allow air to pass through and do not compress the stomach

- Put on flat shoes, ballet flats or sandals because feet when at rest swell, especially in hot weather. Don't take your shoes off, you couldn't put them back on!
- Always keep a little wool handy: the air conditioning is formidable.
- to favor a seat on the aisle side in order to be able to get up regularly
-to do seated exercises every 30 minutes minimum
- do not take sleeping pills
-to drink regularly throughout the flight, avoiding carbonated drinks
-to wear compression stockings
- In certain high-risk situations, an injection of LMWH (low molecular weight heparin) may be performed on the morning of departure.

Other tips:
- Avoid overeating;
- Fasten the seat belt under the belly. Tilt your seat after the take-off phase so as not to compress your abdomen;
- Avoid flying in the last month of pregnancy and within seven days of delivery.

And the baby?
- A baby can travel on the knees of his parents after possible agreement of his pediatrician.
- Most airlines allow the travel of a newborn from the age of one week for a short flight, and from the age of 3 weeks for a long-haul flight.
- Ask for a baby seat.
- Have your baby breastfeed on take-off and landing to prevent the impression of clogged ears.

Well, Bon voyage, nesiah tova!