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Pregnancy and Breastfeeding


Travelling during pregnancy is usually possible but there are important things to consider. Always seek a medical checkup before planning your trip and again shortly before departure. back to top

Air Travel

Most airlines will not accept a traveller after 28-32 weeks of pregnancy and long flights in the later stages can be very uncomfortable. The most risky times for travel are during the first 12-15 weeks of pregnancy when miscarriage is more likely and after 30 weeks when complications such as high blood pressure (pre eclampsia) are more common. For further information regarding air travel and pregnancy please contact your specific airline. back to top

Facilities After Arrival

Antenatal facilities vary greatly between countries and you should think carefully before travelling to a country with poor medical facilities or where there are major cultural and language differences from home. This could be important if you have health problems such as threatening to miscarry or going into early labour. Illness during pregnancy can be more severe so take special care to avoid contaminated food and water and insect and animal bites. Avoid partially cooked meat, unpasteurised milk products and soft cheeses. In some countries infections such as tuberculosis or meningitis can be spread from close personal contact with locals and these can be serious during pregnancy both to yourself and your unborn child. back to top

Vaccinations and Malaria Prevention During Pregnancy and Whilst Breastfeeding

Pregnancy

A general rule is that most recommended vaccines should be used if the risk of infection is substantial because both the mother and the baby could be at serious danger if the traveller were to contract infections such as typhoid and hepatitis. Malaria is particularly serious in pregnancy, frequently resulting in death of the foetus or premature labour and the infection during pregnancy is often more severe than at other times.
Vaccinations
Vaccines are best avoided if they contain live organisms (e.g. yellow fever and MMR), however, WHO states that vaccination against yellow fever may be considered in early pregnancy depending upon the risk.[1] Live virus vaccines work though multiplication within the recipient and inducing an immune response. It is reassuring however to know that there is little evidence that vaccines have ever caused harm to the baby when they have been given inadvertently (e.g. when pregnancy was not thought likely at the time).[2] [3] Most non live vaccines can be used if the risk of infection is high.[3] Tetanus immunisation (a first primary course or any scheduled boosters) is specifically indicated during pregnancy when hygiene may be poor around the time of delivery to prevent tetanus neonatorum from contamination of the umbilical cord stump.
Malaria prevention
Many authorities consider it inadvisable to go to an area with a high risk of malaria during pregnancy if it is not essential, especially if drug resistance is present. Taking all possible efforts to avoid mosquito bites is essential and immediate medical attention should any sought should any fever occur.
  • Chloroquine and proguanil are drugs which have been used extensively for many years without observed foetal damage and are generally consider to be safe in pregnancy. However there is a lot of resistance to these drugs, especially in sub-saharan Africa.
  • Doxycycline effects tooth and bone development in the foetus and must be avoided during pregnancy. No guidelines are available from the manufacturers as to how long after stopping doxycycline pregnancy can be considered but the UK malaria advisory board (ACMP) suggests waiting 1 week.
  • Atovaquone/proguanil (Malarone®) should also not normally be used during pregnancy since insufficient data is available to know whether it is safe. The ACMP advises waiting 2 weeks after discontinuing before becoming pregnant.
  • Mefloquine is probably safe but is ideally reserved for use after the first trimester although there has been no evidence that it has ever harmed the foetus based on experience of its inadvertent use by those who become pregnant while taking it.[4] The manufacturers recommend that pregnancy is ideally best avoided for 3 months after discontinuing mefloquine as a precaution.
The Royal College of Obstetricians and Gynaecologists has published the first edition of guidelines for The Prevention of Malaria in Pregnancy. The aim is to provide evidence based, up to date information for those advising women residing in the UK who are travelling to malaria endemic areas and are pregnant, breastfeeding or planning to become pregnant. Further information on malaria prevention can be found in Malaria Prophylaxis Prior to Conception and in Pregnancy.

Breastfeeding

If a breastfeeding mother receives vaccinations or chemoprophylaxis, small quantities of antigen or drug may be transferred to the baby. While this does not normally cause any problems, this cannot be relied upon to induce effective immunity or give protection to the baby. Allergy to these antigens or drugs is possible but unusual.

Note: As there is a probable risk of transmission of the vaccine virus strain to the infants from breastfeeding mothers, STAMARIL® should not be given to nursing mothers unless when clearly indicated, such as during an outbreak control, and following an assessment of the risks and benefits. Refer SPC

Malaria chemoprophylaxis

  • Doxycycline is not recommended for a mother who is breast feeding due to the risk of tooth and bone problems in the child.
  • Mefloquine is excreted in breast milk but any risk to the infant is minimal. Therefore mefloquine appears safe to use during breast feeding.
  • Atovaquone/proquanil has a lack of supporting data for its use whilst breast feeding. However experience suggests that it is safe to use and may be considered during breastfeeding when there is no suitable alternative antimalarial.

Infant Feeding and Bottled Water

In most countries that belong to the European Union and in North America, tap water is considered to be safe. However, tap water in other countries may not be so safe. When travelling with babies the use of bottled water is considered to be a convenient and usually safer option for making infant formula feeds. There are a few simple rules that parents and guardians should follow when preparing formula feeds during travel:
  • Always check the label for the sodium content in bottled water. A sodium content of less than 0.2g/l or 200mg/l is considered safe.
  • Always check the seal on bottled water. If it is broken do not use it.
  • Visually check bottled water. If it looks dirty it probably is!
  • Stick to bottled mineral water. It is a legal requirement in the UK, that all analytical data is displayed on the label i.e. amount of sodium.
  • Avoid spring or natural water as they may contain high amounts of sodium. It is not a legal requirement in the United Kingdom for all analytical data to be displayed on the labels of spring or natural bottled water.
  • Try to use bottled water that is produced by a recognised manufacturer.
  • Always boil bottled water before using it, allow it to cool for no more than 30 minutes, in accordance with instructions on the formula pack.

Records

It is important to get the all clear from your own doctor or obstetrician before departure. Taking written records including details of your blood group are likely to be helpful if you need medical attention while away. back to top

Insurance

It is essential to check that your insurance policy not only covers you but also your unborn child. Remember insurance policies are only as good as the facilities available.
     
     
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