The indispensable
- Travel during pregnancy should be carefully assessed due to infectious, accidental and obstetric risks, with prior medical advice essential.
- The most favorable period for travel is between 12 and 28 weeks of gestation, and specific precautions are necessary for transport, physical activities, and altitude.
- Updating vaccinations, chosen according to a benefit-risk balance, and taking out appropriate insurance are essential.
- Strict food hygiene is essential to prevent maternal and fetal infections, particularly in cases of traveler's diarrhea.
- Protection against mosquitoes is central, as malaria and arboviruses (dengue, chikungunya, Zika, Oropouche) can lead to serious maternal and fetal complications.
- In areas where malaria is unavoidable, appropriate chemoprophylaxis should be prescribed despite the limitations of available data.
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The decision to travel during pregnancy should be carefully considered due to possible exposure to accidental or infectious risks.
Before departure, pregnant women are advised to:
- Seek the advice of a doctor or midwife regarding the possibility, based on their medical history and the progress of their pregnancy, of safely undertaking the planned trip;
- Bring photocopies or digital files of medical documents related to pregnancy monitoring: maternity booklet, ultrasound results, blood test results;
- Obtain a medical certificate stating that there are no contraindications to travel, particularly by air;
- Evaluate with a doctor, depending on the type of trip and the destination, the relevance and benefit-risk balance of vaccinations (table below) and preventive and curative treatments related to the trip;
- Take out repatriation/hospitalization insurance covering the geographical area concerned.
Vaccinations for pregnant or breastfeeding women who travel
| vaccination | Pregnant woman | Breastfeeding woman |
|---|---|---|
| Chikungunya | Not recommended | Not recommended |
| Whooping cough (in association) | Recommended | Recommended |
| Covid-19 | Recommended | Recommended |
| Dengue | Contraindicated | Contraindicated |
| Diphtheria (in association) | Possible | Possible |
| Japanese encephalitis | Possible | Possible |
| Tick-borne encephalitis | Possible | Possible |
| Yellow fever | Should not be used (live vaccine), except when genuinely needed after benefit/risk assessment. Limited data. |
Breastfeeding an infant < 6 months: possible provided that breastfeeding is suspended for the following 2 weeks. Breastfeeding an infant ≥ 6 months: possible. |
| Typhoid fever | Possible (polysaccharide vaccine). The live attenuated oral vaccine is contraindicated. |
Possible (polysaccharide vaccine). The live attenuated oral vaccine is contraindicated. |
| Flu | Recommended | Recommended if at risk |
| Hepatitis A | Possible | Possible |
| Hepatitis B | Possible | Possible |
| Meningococcus B or ACWY | Possible | Possible |
| Pneumococcus: • Conjugated • Polysaccharide |
Possible. Limited data. Only after a benefit/risk assessment. |
Possible. Limited data. Only after a benefit/risk assessment. |
| Injectable poliomyelitis (alone or in combination) | Possible | Possible |
| Rage | Possible | Possible |
| Measles (associated with rubella and mumps) | Contraindicated | Possible |
| TB | Not indicated | Not indicated |
| VRS | Recommended | Not indicated |
The aircraft
Most airlines do not allow pregnant women to board after the 36th week of amenorrhea (WA) for singleton pregnancies, and after the 32nd WA for multiple pregnancies. Long-haul flights are not recommended in late pregnancy. The best time to travel is between the 12th and 28th WA.
Air travel requires increased vigilance regarding the risk of thrombophlebitis. To prevent deep vein thrombosis, the recommendations are the same as those for the general population (see link to relevant page).
Sea Cruises
Pregnant women are no longer accepted on cruise ships after 28 weeks of gestation.
The Car
Long car journeys, especially on poor roads or tracks, are not recommended.
Physical or leisure activities
Travel often leads to unusual or increased physical activity, which can increase the risk of premature birth.
Some sporting activities are incompatible with pregnancy (trekking, canyoning, scuba diving) and in general, physical activities are not recommended above 2000 m altitude.
Food hygiene
Traveler's diarrhea is common, often temporary, but it can sometimes be severe. Food can transmit more serious non-diarrheal illnesses to pregnant women or pose a risk to the fetus. hepatitis E, toxoplasmosis, listeriosis, coxiellosis, brucellosis...
It is therefore essential to strengthen dietary guidelines for pregnant women, particularly regarding the consumption of raw vegetables, raw milk products, cured meats and undercooked meats.
Recommendations for traveler's diarrhea are the same as those for the general population (see link to corresponding page).
Protection against arthropods
It is recommended to carefully follow the guidelines for protection against arthropod bites (see link to relevant page). Several repellents can be used by pregnant women (check the manufacturer's recommendations on the bottle).
For breastfeeding women, all repellents can be used according to the recommendations but should not be applied to the breasts and hand washing is recommended before breastfeeding.
Specific recommendations regarding vector-borne diseases
Malaria
Malaria can cause acute and severe symptoms in pregnant women, including risks of fetal death. in utero, stillbirths, and the occurrence of severe malaria attacks. A stay in a malaria-endemic area may be inadvisable when the level of exposure is high.
Personal vector protection measures (PPAV) are the same as for the general population; however, skin repellents must be used at appropriate concentrations ((see link to corresponding page).
Choice of chemoprophylaxis in case of pregnancy or possibility of pregnancy during the stay:
A very high level of exposure, the health status of the expectant mother and the contraindication of certain antimalarial molecules in pregnant women may lead the practitioner to advise against certain trips for a pregnant woman.
If, however, a stay in a malaria transmission zone cannot be avoided, it is essential that the pregnant woman take chemoprophylaxis, if indicated, despite insufficient information or the potential side effects of the available molecules, given the risks associated with this disease.
- The atovaquone-proguanil combination may be prescribed in cases of unavoidable travel to areas where this combination is recommended for prophylaxis. Monitoring of pregnancies exposed to the atovaquone-proguanil combination is currently insufficient to definitively rule out any risk of malformations or fetotoxicity.
- Doxycycline is not recommended during the first trimester of pregnancy and is contraindicated from the second trimester onwards (it exposes the unborn child to the risk of staining of the milk teeth).
- As in the general population, mefloquine is now only considered as a last resort due to its potentially serious side effects (contraindicated in cases of neuropsychiatric or depressive history). Nevertheless, it may be prescribed in cases of unavoidable travel to areas where this drug is recommended, in the absence of any other alternative and despite its potential side effects. Analysis of a large number of exposed pregnancies has not revealed any specific malformations or fetotoxic effects related to its prophylactic use.
- Chloroquine is no longer recommended for malaria chemoprophylaxis in the general population and should not be used in pregnant women due to its genotoxic potential. It is no longer marketed in France.
Choice of chemoprophylaxis in case of breastfeeding
Given the very low excretion of antimalarial drugs in breast milk, the concentrations reached are insufficient to ensure effective malaria prevention in breastfed infants. Therefore, if chemoprophylaxis is indicated, it must also be administered to the infant, even if the mother is taking any preventive treatment herself.
Several factors must be taken into account when choosing chemoprophylaxis:
- Atovaquone-proguanil is the recommended first-line treatment if the breastfed infant weighs at least 5 kg. This weight restriction, justified as a precautionary measure due to the limited data available to date, may not be applied, as recommended by the WHO, in cases of urgent need for chemoprophylaxis.
- Mefloquine passes into breast milk and should be avoided as a precaution. The low concentrations found in breast milk and the absence of any adverse events reported to date in breastfed infants have led the WHO to consider its use possible. However, the risk of psychiatric side effects makes it unsuitable for pregnant women who have never taken it before, given that good tolerability cannot be predicted and the increased risk of psychological disturbances during the postpartum period.
- Doxycycline is contraindicated in France for breastfeeding women due to the risk of adverse effects on the child's teeth.
- Chloroquine is contraindicated due to excretion in breast milk that can reach 12% of the maternal daily dose, and its genotoxic potential. It is no longer recommended for malaria chemoprophylaxis in the general population and is no longer marketed in France.
Intermittent preventive treatment in areas of high transmission
Intermittent preventive treatment with sulfadoxine-pyrimethamine or artemisinin-based combination therapies, implemented in some countries with high malaria transmission in pregnant women, is not recommended for pregnant women who travel.
The dengue
Dengue fever can cause spontaneous miscarriages in the first trimester and fetal death. in uteroPremature birth and fetal growth restriction are possible risks. In cases of infection close to term, the risk of postpartum hemorrhage and neonatal dengue is increased. Transmission to the newborn is possible through breastfeeding; breastfeeding should be suspended during the feverish period of dengue and for the following six days. Prevention relies on individual protection against mosquitoes and, in some cases, vaccination before the start of pregnancy.
Chikungunya
Mother-to-child transmission of chikungunya is:
- Rare before 22 weeks of gestation but can lead to fetal death;
- Common near term and can cause severe neonatal infections with encephalopathy.
Prevention relies on individual protection against mosquitoes, and in some cases, on vaccination before the start of pregnancy.
Zika
Mother-to-child transmission of the Zika virus is possible throughout pregnancy. It is most likely if the maternal infection occurs in the first trimester and can lead to congenital Zika syndrome in 6% of cases, sometimes with very severe brain damage (see disease page).
Recommendations for pregnant women planning a trip to an area where the Zika virus is circulating, and for those planning a pregnancy who are planning a trip to an area experiencing a Zika epidemic, are available in the HCSP opinion of February 16, 2017:
Source: Guide to Health Recommendations from the High Council for Public Health for Travellers
