PregnancyPregnancy during travel carries important risks that should be considered carefully prior to booking the trip
With careful preparation, most pregnant women are able to travel without experiencing health problems.
Pregnant women should see their travel health advisor 6-8 weeks before travel (for those with less time an appointment is still worthwhile).
Women should research health risks and medical facilities at their destination and obtain comprehensive travel health insurance prior to travel.
Pregnant women have an increased risk of developing severe malaria and dying from malaria compared to non-pregnant women. If travel to a risk area is essential, careful insect bite avoidance is important, antimalarial tablets should be taken (see below) and women should seek prompt medical advice if symptoms of malaria occur.
Inactivated vaccines can be given if clinically indicated. Live vaccines pose a theoretical risk to a fetus, they may be considered following expert consultation for those at particular risk of disease. Unfortunately, uptake rates of vaccination during pregnancy are often low.
Pregnancy increases the risk of venous thromboembolism (VTE), for travel over four hours, women should mobilise their legs at regular intervals and consider wearing properly fitted, below knee, graduated compression stockings. For those with additional risk factors low weight molecular heparin may be advised.
Limited data suggests that many pregnant women travel without experiencing health problems . However, pregnancy during travel carries important risks that should be considered carefully prior to booking the trip.
Pregnant women with a significant obstetric history, an inadequately controlled or newly diagnosed medical condition, or those who are planning to travel to malaria affected areas, or areas without access to medical care, should be advised against non-essential travel. If travel is essential, the advice below should be discussed.
A careful review of the travel plans and medical history should guide the pre-travel health advice. Pregnant travellers should be encouraged to access information on pregnancy and travel. See resources for travellers below.
Destination-specific health advice can be found on the Country Information pages.
Comprehensive travel insurance is essential for all travellers. A full declaration of medical conditions, including pregnancy, should be made to the insurers. Insurance policies differ in their terms and conditions, pregnant women should check that the policy will cover the cost of medical treatment if a pregnancy related problem occurs, including the care of the pre term baby and repatriation costs if appropriate. All equipment and planned activities should be covered.
The risks to pregnant women and their newborn babies following COVID-19 infection has increased over the course of the pandemic. During the period when the Delta variant virus was dominant, six newborn deaths were recorded compared to none in previous waves.
The proportion of pregnant women hospitalised with symptomatic COVID-19 that experienced moderate to severe infection and the proportion admitted to intensive care units also increased . Recent studies indicate that pregnant women are more likely to be admitted to an intensive care unit, have invasive ventilation or extracorporeal membrane oxygenation in comparison to non-pregnant women of reproductive age .
Recent UK studies have suggested a high rate of stillbirth in infected women . The risk of pre-term birth is also increased two to threefold for those who develop symptoms of COVID-19 infection usually, due to medical intervention to help improve the breathing of the mother .
Pregnant women are more likely to develop severe infection if they are overweight or obese, are of black and Asian minority ethnic background, have medical conditions such as diabetes, heart disease, increased blood pressure, asthma or are 35 years or older . See the NHS page on pregnancy and coronavirus for further information.
All individuals should follow current UK recommendations to reduce their risk of infection but particularly those who are at higher risk, see current guidance for those previously considered clinically extremely vulnerable from COVID-19. Travellers should also consider whether postponing travel would be appropriate.
In recognition of pregnancy as a risk factor for severe COVID-19 infection and poor pregnancy outcomes during the Delta wave, pregnancy was added to the clinical risk groups eligible for immunisation including boosters . See UKHSA COVID-19 chapter 14 a in ‘the Green book’ Immunisation against infectious disease for further details. It is strongly recommended that pregnant women get their COVID-19 vaccinations.
The COVID-19 vaccines available in the UK have been shown to be effective and to have a good safety profile. These vaccines do not contain live coronavirus and cannot infect a pregnant woman or her unborn baby in the womb. The Pfizer BioNTech or Moderna vaccines are preferred for pregnant women as there is extensive post-marketing experience of their use in pregnancy with no safety concerns so far . However, for those under 18 years of age, the Pfizer BioNTech vaccine (Comirnaty®) is preferred. Pregnant women who commenced a course with the AstraZeneca vaccine, can complete with the same vaccine .
General guidance regarding risk assessment for travel during the COVID-19 pandemic is available. More detailed information on pregnancy and coronavirus is available from the Royal College of Obstetricians and Gynaecologists.
The early pregnancy scan (usually performed between 10 to 13 weeks gestation) should ideally be performed prior to travel to ensure the viability of the pregnancy and confirm the gestation.
Travel with certain pre-existing medical conditions or obstetric complications is not recommended, specific advice should be obtained from the obstetrician. Conditions such as cervical insufficiency, pre-eclampsia, premature rupture of membranes, placental abruption, suspected ectopic pregnancy and vaginal bleeding are likely to be considered contraindications to travel .
Specific advice should also be obtained for those with complicated past or current pregnancies such as history of miscarriage, ectopic pregnancy or infertility, multiple gestation (e.g. twins, triplets etc).
Ante-natal records and next of kin details should be carried when travelling.
Appropriate gynaecological, obstetric and neonatal care may be limited or non-existent in some areas. Emergency plans should be made in advance of travel.
Fitness to fly
Commercial air travel is considered safe in uncomplicated pregnancies up to 36 weeks and up to 32 weeks for a multiple pregnancy . Pregnant women should check the airline’s requirements when booking flights.
After 28 weeks most airlines require a medical certificate confirming the estimated date of delivery and that there are no complications .
The date of the return journey should also be considered.
Women with high-risk pregnancies, including placental abnormalities or risk of premature labour, should avoid flying (see details in the pre travel preparation section).
Cruise liner companies may decline to carry pregnant women in the mid to later stages of pregnancy. Pregnant women should check the individual cruise line requirements when booking and take into account any restriction relating to connecting flights .
Travel-related Venous thromboembolism (VTE)
Pregnancy increases the risk of venous thromboembolism (VTE) including deep vein thrombosis and pulmonary embolism. This is especially a concern when travelling long distances, as legroom may be restricted and passengers can be required to sit still for long periods of time. On long haul journeys over four hours, pregnant travellers should walk around at regular intervals, wear comfortable, loose clothingregularly flex and extend the ankles to encourage blood flow from the lower legs and sit in an aisle seat if possible [6-9]. Some guidelines recommend that pregnant women wear properly fitted, below knee, graduated compression stockings providing 15 to 30mmHG of pressure at the ankle during travel for flights lasting more than 4 hours [6, 7]. However, a 2019 review considered the evidence for the use of graduated compression stockings to be limited, but that they could be considered for pregnant travellers, including for those with additional VTE risk factors .
Those with additional risk factors for VTE may also be advised to have low weight molecular heparin whatever the duration of the flight [7-9].
Further information on Travel Related Venous Thromboembolism (VTE) is available on the TravelHealthPro website.
Motion sickness can exacerbate pregnancy-induced nausea [7, 10].
Food and water-borne risks
Unpasteurised dairy products, under-cooked meat and soft cheeses must be avoided during pregnancy. Pregnant women risk serious complications if they contract hepatitis E  or other diseases such as listeriosis or toxoplasmosis .
The effect of gastrointestinal illness in pregnancy can be significant for both mother and fetus. Careful food, water and personal hygiene should be emphasised.
Medications licensed for use in pregnancy can be prescribed to treat gastrointestinal illness. Specialist advice should be sought before prescribing unlicensed products. Ciprofloxacin and loperamide are not recommended for pregnant women.
Oral rehydration solutions should be used to prevent dehydration if travellers’ diarrhoea occurs; these are relatively cheap and lightweight to carry in the first aid pack.
Pregnant women should seek prompt medical attention if they are showing signs of dehydration or if diarrhoea is prolonged, there is blood/mucous in the stool or a fever.
(Including malaria and the viruses chikungunya, dengue and Zika)
All pregnant women who live in or travel to areas where mosquito-borne diseases are known to occur should take measures to avoid being bitten day and night. Malaria is transmitted by Anopheles mosquitoes, a night-biter; chikungunya, dengue and Zika viruses are transmitted by Aedes mosquitoes, a day-biter.
DEET has a good safety record in pregnancy; repellents containing 50 percent DEET can be recommended for pregnant women [11, 12]. For those considering the use of alternative active ingredients, the UK teratology information service (UKTIS) review of insect repellents in pregnancy 2018, found there are no data relating to exposure of Icaridin (Picardin) and Eucalyptus citriodora oil in human pregnancy, however animal studies have not demonstrated any features of maternal or developmental toxicity . UKTIS did not comment on 3-ethlyaminopropionate (IR3535) repellents in their review.
DEET can be applied to natural fibres such as cotton clothing and exposed skin. However, DEET can damage synthetic fabrics and items like plastic watch straps or jewellery, so care should be taken with these items .
Pregnant women should also use protective clothing and sleep under an insecticide treated mosquito net, if they are not in air-conditioned accommodation. Although room protection such as air conditioning and screening at the windows is important, it should not be used in isolation, other bite avoidance measures are still required .
Pregnant women should be informed of the risks of travel to countries where malaria is known to occur. They should consider postponing their trip, unless travel is unavoidable .
Pregnant women are more susceptible to mosquito bites and therefore more vulnerable to malaria .
Ideally, pregnant women should remain indoors between dusk and dawn. If they must be outdoors at night, they should adhere rigorously to bite precautions .
Malaria in pregnancy increases the risk of maternal death, miscarriage, stillbirth and low birth weight, with associated risk of neonatal death [12, 13].
Diagnosis of falciparum malaria in pregnancy can be difficult as parasites may not be detectable in blood films due to sequestration in the placenta .
If travel is essential, the ‘ABCD’ of malaria prevention should be discussed:
- Awareness of the risk
- Bite prevention
- Chemoprophylaxis (antimalarial medication)
- Diagnosis and prompt treatment
Pregnant women and those planning to conceive should be Aware of the risks, understand the importance of effective mosquito Bite prevention; DEET has a good safety record in pregnancy and repellents containing DEET at 50 percent concentration can be recommended . Appropriate Chemoprophylaxis should be taken and pregnant women should be aware of the symptoms of malaria (particularly high fever) and the importance of prompt Diagnosis and treatment.
Contraindications, side effects and drug interactions must be considered carefully prior to prescribing antimalarials in pregnancy.
Chloroquine and proguanil are safe in all trimesters. However, these drugs offer poor protection against malaria in many areas due to widespread Plasmodium falciparum drug resistance. Pregnant women who take proguanil should also take 5mg of folic acid daily, for the length of time that proguanil is taken .
Doxycycline is contraindicated in pregnancy but may, in special circumstances, be considered if required before 15 weeks gestation where other options are unsuitable. The full course of doxycycline, including the four weeks after travel must be completed before 15 weeks gestation . The UK teratology information service (UKTIS) states that exposure to doxycycline at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, they highlight that other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case specific risk assessments .
Mefloquine can be offered to pregnant women during the second and third trimesters and in the first trimester where travel to a high-risk area for P. falciparum malaria is unavoidable . It seems unlikely that mefloquine is associated with adverse outcomes for the fetus (unborn child). Inadvertent use of mefloquine just prior to or during the first trimester does not constitute grounds to terminate the pregnancy .
The use of atovoquone plus proguanil (AP) combination preparation in pregnancy is generally not advised due to sparse data . However, the individual components have shown no adverse effects on parturition or pre- and post-natal development and animal studies show no evidence for teratogenicity [12, 15]. Therefore, following careful risk assessment, AP can be considered in the second and third trimesters of pregnancy, where other options are unsuitable. Folic acid 5 mg daily should be taken for the length of time that atovaquone/proguanil is taken in pregnancy .
A study of inadvertent AP use from weeks three to eight after conception identified 149 pregnancies and found no significant association between AP exposure in early pregnancy and risk of a major birth defect . An anonymous, internet-based survey to describe outcomes of pregnancies accidentally exposed to AP identified 10 pregnancies with AP exposure in the first trimester. All resulted in full-term births with no birth defects .
A study of 198 women who received AP in pregnancy, 79.8 percent of them in the first trimester, did not show a specific signal to suggest a teratogenic effect, but numbers were too small confidently to determine safety of this combination in pregnancy .
A systematic review of the safety of AP for malaria prevention and treatment in pregnancy suggested that the rates of adverse events are not higher than the expected rates in similar populations .
Inadvertent use of AP combination preparation just prior to or during the first trimester does not constitute grounds to terminate the pregnancy .
A review of malaria in the pregnant traveller has been published .
Pre-conception and antimalarials
Travellers who plan to become pregnant after taking antimalarials and wish to do so with minimal antimalarial drug present, may elect to observe the following time intervals after completing the course, before attempting to conceive :
- one week following doxycycline use.
- two weeks following atovoquone plus proguanil combination preparation.
- three months following mefloquine use.
Women planning conception in countries with a high risk of chloroquine-resistant P. falciparum malaria should seek specialist advice.
- Use of mefloquine may be considered after careful risk assessment .
- Doxycycline may be considered in special circumstances if the full course including the four weeks after travel will be completed before 15 weeks gestation (see information above) .
- Chloroquine and proguanil provide poor protection in areas with a high risk of chloroquine- resistant P. falciparum malaria. Women taking proguanil who are planning to conceive should receive supplementation with 5mg of folic acid daily (prescription dose) for the length of time that proguanil is taken.
Mother to child transmission of chikungunya virus infection has been reported in women who were infected with the virus in the later stages of pregnancy and had fever in the days immediately prior to or during labour [21-23].
While pregnancy is not thought to increase the incidence of this disease, pregnant women are at risk of severe complications associated with of dengue infection . Mother to child transmission during delivery has also been associated with severe dengue in newborns .
Pregnant women should be informed about the risks of adverse pregnancy outcomes with chikungunya and dengue with some suggesting that pregnant women should consider avoiding unnecessary travel to affected areas, particularly in the third trimester due to the risk associated with mother to child transmission and maternal consequences .
Zika virus is a cause of Congenital Zika Syndrome (microcephaly and other congenital anomalies) [23, 24]. In areas where there is evidence of a current outbreak of ZIKV with significant transmission, pregnant women are advised to postpone non-essential travel until after the pregnancy.
In areas where recent outbreaks have been previously reported, re-introduction of ZIKV or endemic transmission has occurred, pregnant women are advised to consider postponing non-essential travel until after the pregnancy.
Recommendations for affected countries are found in the ‘other risks’ section of our Country Information pages. If travel to a risk area is essential, pregnant women should be aware of this risk and they should be scrupulous with mosquito bite avoidance day and night. Also, pregnant women who visited Zika risk areas while pregnant, or who become pregnant within 2 months after their last possible Zika exposure*, should contact their GP, obstetrician or midwife for further advice, even if they have not been unwell.
This advice does not apply to areas considered to be at “very low risk” of ZIKV (see Country Information pages). Further information on Zika is available from Public Health England.
*Last possible Zika virus exposure is defined as the later of either the date of leaving a country or area with risk for ZIKV transmission, or the date on which unprotected sexual contact with a potentially infectious partner took place.
Health professionals should refer to the relevant chapters in Public Health England, Immunisation against Infectious Disease ‘Green book’ for information about specific vaccines before vaccinating a pregnant woman.
A recent a comprehensive review of the evidence on safety of various non-live vaccines during pregnancy (those based on inactivated virus, inactivated bacteria, and the acellular vaccines and toxoids) revealed no safety issues. Pregnancy should not preclude women from vaccination with these vaccines if medically indicated [25-27]. Unfortunately, uptake of vaccination programmes for pregnant women has been low in some areas . Barriers to vaccination in pregnancy are complex and vary depending on context and population .
Since September, 2012 pertussis (whooping cough) vaccine has been offered to all pregnant women in the UK (including those previously immunised), during late pregnancy. This vaccination programme was introduced in response to increased levels of pertussis activity across the UK. The aim of this is to boost immunity in the mother during pregnancy to optimise transfer of antibodies from mother to unborn baby and thereby protect the infant from birth until they reach the age of routine immunisations (2 months) . This inactivated vaccine is given in combination with low dose diphtheria, tetanus and inactivated polio.
Pertussis vaccination is currently recommended for pregnant women from 16 weeks to 32 weeks of pregnancy, although the vaccine can be offered after 32 weeks (vaccination should be offered from around 20 weeks, on or after the foetal anomaly scan) . Pertussis vaccination administered before 16 weeks gestation may not provide adequate protection against pertussis for the infant; pregnant women requiring protection against diphtheria, tetanus or polio for travel before 16 weeks gestation should be offered Revaxis®. Such women will, in addition, receive the routine pertussis vaccine at an appropriate time during their pregnancy; a four week minimum interval between vaccines is recommended .
Most live vaccines are contraindicated or not recommended in pregnancy because of the theoretical risk that the live attenuated virus or bacteria (in the vaccine) may cross the placenta and infect the fetus. However, some live vaccines may be considered in circumstances where the risk of disease outweighs the risk of live vaccination during pregnancy [25, 26, 31]. Specialist advice should be sought when travel is essential and live vaccines are being considered.
Yellow fever vaccination should generally be avoided, on theoretical grounds, during pregnancy and particularly the first trimester . However, where travel to a high risk area for YF cannot be avoided, the vaccine can be considered following individual risk assessment, which should take into account potential risk from the vaccine and risk of exposure to YF disease [25, 31].
Inadvertent administration of a vaccine (live or inactivated) during pregnancy does not constitute grounds to terminate the pregnancy .
In order to expand the safety data available on vaccines for pregnant women, it is desirable that health care professionals report details of vaccine use during pregnancy to the UK Teratology Information Service, a group commissioned by Public Health England, as well as to the vaccine manufacturers. These groups collect pregnancy outcome information from women who have been exposed to drugs and vaccines in pregnancy.
Pre-conception and vaccines
Vaccinating prior to conception is preferable to vaccination during pregnancy. However, because of the theoretical risk of live vaccine virus transmission to the foetus, women should be advised to delay conception for 28 days after receiving live vaccines.
Other health risks
There is a lack of data on the effects of exposures to high altitude during pregnancy . It is prudent to avoid high altitude in the first trimester and advisable that at least one scan has been performed to confirm a healthy intrauterine pregnancy . After 20 weeks gestation short stays (hours to days) at altitudes up to 2,500m without heavy exercise in women with uncomplicated pregnancies are thought to pose minimal risk .
The World Health Organization (WHO) state that travel to sleeping altitudes over 3,000m or to remote areas is not advisable during pregnancy .
Women with complicated pregnancies of any gestation should avoid travel to high altitude travel including those with anaemia, chronic or pregnancy-induced hypertension (or risk factors for pre-eclampsia), impaired placental function (ultrasound diagnosis), intra-uterine growth retardation, maternal heart or lung disease and unexplained bleeding.
The Summary of Product Characteristics for acetazolamide states that this drug should not be used during pregnancy, particularly during the first trimester .
Body temperature regulation is not as efficient during pregnancy. In addition, an increase in core temperature, such as with heat stroke, may harm the fetus . If visiting countries with hot climates pregnant women should consider choosing accommodation with air-conditioning and restrict activities in the heat.
Anxiety during pregnancy can be exacerbated by travel. These issues should be discussed prior to travel and/or specialist advice sought when necessary.
Pregnant travellers should pack a first aid kit that will also help them manage relevant, common issues affecting pregnant women such as constipation, haemorrhoids, indigestion and morning sickness.
Before travel it is sensible to research the medical facilities available at the destination. Pregnant women should also know when to seek prompt medical advice, for example if they experience abdominal pain, bleeding, contractions, prolonged diarrhoea or signs of dehydration, fever, rupture of membranes, symptoms of preeclampsia, vomiting or other concerning symptoms.
It is advisable to carry the emergency contact numbers for the insurance company; who should be contacted early if medical help is required.
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First Published : 02 Jan 2015
Last Updated :  29 Dec 2021