[Pregnancy and traveling].

The second trimester is the safest time for travelling, because the pregnant woman feels generally most at ease and the risk of spontaneous abortion and pre-term labour is very low. Possible risks must be discussed with the obstetrician before travelling. If the pregnancy is uncomplicated most airlines allow flying up to the 36th (domestic flights) and 35th (international flights) week of gestation. Unless the fetal oxygen supply is already impaired at ground level due to an underlying disease, flying does not pose a risk of fetal hypoxia. Radiation exposure during a long distant flight is low compared to the average annual exposure dosage, but the risk of thrombosis is increased. Altitudes up to 2,500 m pose no problem. Sufficient time to acclimatize must be taken when travelling to high altitudes and exercise kept to a minimum. Scuba diving is contraindicated. Since only a few drugs are completely safe during pregnancy a thorough risk/benefit evaluation is mandatory. Treatment of infections can be considerably complicated, but any necessary treatment should not be withheld because of the fear of potential fetal injury. Good knowledge of local medical resources is essential before travelling. Several personal protective measures minimize the risk of infection: food and water precautions, protection from insect bites and avoidance of crowds, unsafe sex and, if need be, freshwater. Many vaccinations are recommended for travellers. However, live vaccines are contraindicated in pregnant women because of theoretical considerations. Exceptionally a yellow fever vaccination may be given after the first trimester. Killed, inactivated or polysaccharide vaccines can be given after the first trimester after a thorough risk/benefit evaluation. Because of the potentially devastating effect of malaria to the mother and the child, travelling to endemic malaria regions should be avoided. If the risk of infection is high chemoprophylaxis with mefloquine is indicated. In low-risk countries mefloquine, in South-East-Asia artemisinin derivatives should be given as stand-by treatment.