is travel pregnant

Pregnancy Travel Tips

Can you travel while pregnant , read this next, when should you stop traveling while pregnant, how should you prepare for a trip during pregnancy, what do pregnant women need to know about travel and the zika virus, travel tips for pregnant people, when should you seek medical care while traveling during pregnancy.

While traveling during pregnancy is generally considered safe for most moms-to-be, you’ll need to take some precautions before making any plans — and get the green light from your practitioner first.

What to Expect When You’re Expecting , 5th edition, Heidi Murkoff. WhatToExpect.com, Zika Virus and Pregnancy , October 2020. WhatToExpect.com, What to Know About COVID-19 if You’re Pregnant , February 2021. American College of Obstetricians and Gynecologists, Travel During Pregnancy , August 2020. Johns Hopkins Medicine, Traveling While Pregnant or Breastfeeding , 2021. Centers for Disease Control and Prevention, COVID-19 Travel Recommendations by Destination , May 2021. Centers for Disease Control and Prevention, Pregnant and Recently Pregnant People , May 2021. Centers for Disease Control and Prevention, Pregnant Travelers , December 2020. Centers for Disease Control and Prevention, Travel: Frequently Asked Questions and Answers , April 2021. Centers for Disease Control and Prevention, COVID-19 and Cruise Ship Travel , March 2020.

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Here Are the Rules for Flying When You're Pregnant

Whether you're newly pregnant or planning a babymoon right before welcoming your baby, here's what parents-to-be need to know about airline travel during each trimester.

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Expectant parents need to know: Can you fly when pregnant?

While it's mostly OK to travel until the last few weeks of pregnancy, there are some precautions to take depending on when you decide to book a trip and how high risk your pregnancy is. Here's what you need to know before your next vacation.

Pregnancy and Flying: Your Trimester by Trimester Guide

As a general rule of thumb, most airlines will allow pregnant people to fly right up until week 36 of pregnancy, but you should absolutely do your research before booking your flight to check restrictions. You'll also want to consult with your OB-GYN or midwife before traveling—especially if you're at a higher risk for complications during pregnancy.

Before you travel

While you may be accustomed to planning a vacation on a whim or only packing your usual necessities, there's one extra thing you should consider doing before booking a flight during your pregnancy: Opt for travel insurance.

Should travel restrictions change, your health care provider recommends you stay home, or if you experience any concerning symptoms —like bleeding, abdominal pain, swelling, headaches, vision changes, or decreased fetal movement—you'll want to postpone or cancel your plans and see your doctor as soon as possible.

According to the ACOG, travel is not recommended for pregnant people with certain complications like preeclampsia, premature rupture of membranes (PROM), or who are at risk of preterm labor.

First trimester

Flying earlier on in pregnancy is actually considered pretty safe. And, no, metal detectors won't harm your fetus.

"Pregnant women can observe the same basic precautions for air travel as the general public," Raul Artal, M.D., former vice chairman of the American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice, previously told Parents .

One thing pregnant air travelers should take extra precautions to avoid at any trimester? Blood clots, which pregnant people are 7 times more likely to develop—especially during long flights. To help minimize your risk, you can book an aisle seat, walk around every so often, and wiggle your legs and toes while seated.

And since morning sickness and fatigue might be your biggest first trimester complaints, you may want to check with your health care provider about bringing anti-nausea medicine with you.

Second trimester

According to the ACOG, "The best time to travel is mid-pregnancy (14 to 28 weeks). During these weeks, your energy has returned, morning sickness is improved or gone, and you are still able to get around easily. After 28 weeks , it may be harder to move around or sit for a long time."

If you're flying during your second trimester, it's a good idea to stay hydrated, think about wearing support stockings to reduce edema and clot risk, and make sure you've done your research on hospitals located near your destination should an emergency arise.

Carrying twins or more? Your health care provider might recommend you stop traveling earlier due to the higher risk of complications.

Third trimester

How late in pregnancy can you fly? If you're relatively healthy—and not at risk of complications like preterm labor, preeclampsia, gestational diabetes, or placenta previa—then you're usually OK to travel up until 36 weeks, though some OB-GYNs may prefer you stay closer to your home near the end should you encounter any complications or in case your baby comes sooner than expected.

High-risk patients—and especially those with pregnancy-induced hypertension, diabetes, and sickle-cell disease—may be advised not to fly after 24 weeks—or not at all.

Check with your doctor before traveling at the end of your pregnancy.

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Traveling while pregnant: Your complete guide

Unless you're nearing your due date or have certain complications, your healthcare provider will generally give you the green light for pregnancy travel. Here's how to safely explore – plus what to consider before making plans.

Is traveling while pregnant safe?

When to avoid pregnancy travel, when is the best time to travel while you're pregnant , can pregnant women travel during covid, when should you stop traveling while pregnant, your pregnancy travel checklist, when to call your doctor while traveling.

Yes, it's generally safe to travel during pregnancy as long as you're not too close to your due date and you're not experiencing any serious pregnancy complications. There are special precautions to take, of course, and you may find yourself stopping to use the bathroom more than you're used to, but that babymoon can be within reach.

Before you pack your suitcase, talk with your healthcare provider to make sure it’s safe for you to travel and that your destination is a good choice. You'll want to avoid places where infectious diseases are prevalent (or there are high outbreaks of Zika or malaria, for example). The COVID-19 pandemic has made people reconsider where they feel safe traveling as well; if you're fully vaccinated, the CDC says you can travel Opens a new window , but it's always best to check with your doctor first.

And bear in mind that the activities you take part in might be different than normal – you'll want to skip the Scuba diving lessons, for example (though snorkeling is okay!).

It's safe to fly when you're pregnant as well, and most airlines will allow you to fly domestically until about 36 weeks of pregnancy. International routes may have different rules, so be sure to check with your airline before booking anything. Your doctor will tell you to avoid flying, however, if you have a health concern that might require emergency care or any other health conditions that aren’t well controlled.

It's best to avoid traveling while pregnant if you have any health conditions that can be life-threatening to both you or your baby. If you have any of the following conditions, your doctor will almost certainly advise you against travel:

• Placental abruption  
• Preeclampsia
• You're in preterm or active labor
• Cervical insufficiency  (incompetent cervix)
• Premature rupture of membranes (PROM)
• A suspected ectopic pregnancy
• Vaginal bleeding

You might also need to be extra-cautious or skip travel if you're experiencing intrauterine growth restriction , you have placenta previa , or you have other conditions that may place your pregnancy at a higher risk. It’s always a good idea to discuss your concerns with your healthcare provider before travel regarding any medical conditions you have, and they'll be able to advise you on what's best, depending on the trip.

The sweet spot for pregnancy travel is during your second trimester , between 14 weeks and 27 weeks. By the second trimester, any struggles you’ve had with morning sickness and fatigue during the earlier weeks of pregnancy should have hopefully subsided – and after 12 weeks, your risk of miscarriage decreases significantly as well. And you're not too far along to worry about third trimester exhaustion or going into preterm labor yet, either.

Your energy levels are likely to be good during your second trimester too (bring on the sightseeing!), and it will still be relatively easy and comfortable for you to travel and move around at this time. Keep in mind that once you hit that third trimester, pregnancy travel might be more difficult as you find it harder to move around and stay still for long periods of time.

It's complicated (and often a personal decision based on your own risk factors), but the CDC says that if you're fully vaccinated against COVID-19, you can travel. Of course, it's important you still do everything you can to keep yourself and others around you safe, including following all mask-wearing and social distancing guidelines in the destination you visit.

Women are at an increased risk for severe illness if they contract COVID-19 while pregnant , and they're more likely to experience preterm birth and other poor pregnancy outcomes. (This is why the CDC, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine all recommend that women who are pregnant, breastfeeding, or are planning on becoming pregnant get the COVID vaccine .)

If you're vaccinated and decide to travel, the CDC advises avoiding international destinations that are designated Level 4, due to high rates of local COVID-19 transmission.

Take all this information into account and talk to your doctor before you decide on where and when to travel while you're pregnant. And if you experience any symptoms of COVID-19, whether while traveling or at home, call your healthcare provider as soon as possible.

The guidelines for when to stop traveling while you're pregnant vary based on your mode of travel, but more or less, you should wrap up travel before you're 36 weeks pregnant.

Most airlines will let pregnant women fly domestically until they're 36 weeks pregnant – and many cut that off earlier for international travel. This rule is often enforced on an honor system policy, but some airlines may ask for a doctor’s note – so make sure you have that from your healthcare provider if you're traveling in the third trimester, just in case.

Most cruise ships don't allow travel after 24 weeks of pregnancy. Some cruise lines' cutoff dates vary, so verify policies before booking a cruise.

As for road trips, there's no official deadline for when you need to stop traveling, but your personal comfort level (physically and emotionally) – and your doctor's advice – might help you decide. You can drive while pregnant all the way up until your due date, but things may get considerably less comfortable on longer trips as you approach full term.  

Travel of any kind requires advance preparation, but when you're pregnant and traveling, that pre-trip checklist gets a little longer. Give yourself a little more time than usual to plan for a trip – and use the tips below to stay safe and comfortable on your next adventure.

Before you travel

• Talk to your healthcare provider to determine if your trip is safe for you and if there are any medical concerns to consider. It's a good idea to discuss any activities you plan to do while you're away too. If you're planning an international trip, make sure to ask about any vaccines you may need for the areas you're visiting.
• Make sure you know your prenatal test schedule. Plan travels around any prenatal tests you need to schedule, including ultrasounds and other important screening tests.
• Book an aisle seat. You'll likely be more comfortable being able to get up to stretch or go to the bathroom on longer flights.
• Buy travel insurance. You don't need special travel insurance when you're pregnant, but it's never a bad idea to secure a policy. You may want to consider one with a “cancel for any reason” clause that reimburses you for money lost on cancelled trips for reasons (read: any reason) beyond what’s listed on the base policy. Check with your personal health insurance, too, to make sure it covers potential pregnancy complications while traveling internationally (some don’t). Consider adding evacuation insurance as part of a travel insurance plan, too.
• Gather your medical records and health information . If you’re in your second or third trimester, ask your ob-gyn or midwife for a digital copy of your prenatal chart, and have that easily accessible during your trip. Typically, this chart includes your age, your blood type, the name and contact information for your healthcare provider, the date of your last menstrual period, your due date, information about any prior pregnancies, your risk factors for disease, results of pregnancy-related lab tests (including ultrasounds or other imaging tests), your medical and surgical history, and a record of vital signs taken at each visit.
• Keep a list of key names and numbers you may need in the event of an emergency saved on your phone and written on a piece of paper (in case your battery dies).
• Have a contingency plan for doctors and hospitals that will take your insurance where you're going in case you go into labor early or experience pregnancy complications that require urgent care while you're away from home.
• Pack medicines and prenatal vitamins. That might include an extended supply of prescriptions and over-the-counter remedies , too. Bring enough to cover your entire trip and a written prescription that you can fill if you lose anything. It's a good idea to keep prescription medicine in its original container, so if your bags are searched it will be clear that you're not using medication without a prescription.
• Prepare for the unexpected. On a road trip, that might mean an unexpected breakdown, so join an auto club that provides roadside assistance. Download any apps you use for renting cars and accessing boarding passes before you leave so you can easily reschedule things in the event of a last-minute cancellation.
• If you're flying during your third trimester, be sure to call the airline to check about the cutoff week for pregnancy travel. A note from your doctor that says you’re cleared to travel is always good to have when traveling during your third trimester.

During your trip

• Drink plenty of water and continue to eat healthy foods . Keep in mind that many restaurants abroad commonly serve unpasteurized foods (like soft cheeses and milk), which can be dangerous for pregnant women due to the presence of listeria.
• Avoid eating raw or undercooked meat or fish , drinks with ice (which may be contaminated), non-bottled water, and other foods that can cause traveler's diarrhea, which can be more of a problem for pregnant women than other people.
• On long flights and drives, take time to stretch by pulling over for a walk or strolling up and down the airplane aisle. And when seated, always wear your seat belt .
• Maternity compression socks are handy to have along – both in transit and worn under your clothes while you’re out and about exploring – because they can ease the symptoms of swollen feet and legs. These are a few of our favorite pregnancy compression socks .
• Take advantage of help. Many countries have dedicated lines in shops and airports for pregnant travelers, so don't feel any shame taking a shorter wait if you see one.
• Go easy on yourself. Remember, you're growing a baby. You might not have quite the stamina for sightseeing and late nights like you used to pre-pregnancy. Make the most of your vacation but don't fret you miss out on things because you need more downtime from exploring than you usually would.
• Don’t forget to get photos of your bump. When your baby is older, you'll have fun showing them all the places you traveled with them before they were born.
• Go for the comfy shoes. Travel during pregnancy is the best reason ever to forgo those strappy stilettos for your favorite sneakers .
• Pack snacks so you always have something to curb your appetite if there’s a long wait for a restaurant or you get stuck in transit or someplace remote with no food offerings.
• Try to be in the moment with your travel partners as much as possible. Once your baby is born, your attention will be pulled in a whole new direction.

If you have any medical concerns traveling while pregnant, don’t hesitate to pick up the phone and call your doctor for advice. The below are a few symptoms that definitely warrant calling your ob-gyn or health care provider or seeking emergency care while traveling or at home:

• Signs of pre-term labor (including a constant, low dull backache, bleeding, etc.)
• Ruptured membranes (your water breaks)
• Severe cramping
• Spiking blood pressure
• Severe nausea or vomiting
• COVID-19 symptoms

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BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

AAFP. 2020. Ultrasound during pregnancy. American Academy of Family Physicians.  https://familydoctor.org/ultrasound-during-pregnancy/ Opens a new window [Accessed April 2023]

ACOG. 2020. FAQ055: Travel during pregnancy. American College of Obstetricians and Gynecologists.  https://www.acog.org/womens-health/faqs/travel-during-pregnancy Opens a new window [Accessed April 2023]

CDC. 2019. Pregnant Travelers. https://wwwnc.cdc.gov/travel/yellowbook/2020/family-travel/pregnant-travelers Opens a new window [Accessed April 2023]

CDC. 2022. Domestic Travel During Covid-19. https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html Opens a new window [Accessed April 2023]

CDC 2023. International Travel During Covid-19. https://www.cdc.gov/coronavirus/2019-ncov/travelers/international-travel-during-covid19.html Opens a new window [Accessed April 2023]

CDC. 2022. Covid-19: Pregnant and Recently Pregnant People. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnant-people.html Opens a new window [Accessed April 2023]

Terry Ward is a freelance travel, health, and parenting writer who has covered everything from flying with toddlers to why you should travel with your kids even when they're too young to remember it. She lives in Tampa, Florida, with her husband and their young son and daughter, and enjoys camping, sailing, scuba diving, skiing, and almost anything else done in the great outdoors.

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• Pregnancy week by week

Is it safe to fly during pregnancy?

Generally, air travel before 36 weeks of pregnancy is considered safe for people who aren't dealing with any pregnancy problems. Still, if you're pregnant, it's a good idea to talk with your health care provider before you fly.

Your provider might suggest that you not fly if you have certain pregnancy complications that could get worse because of air travel or that could require emergency care. Examples include a history of miscarriage or vaginal bleeding, severe anemia, and high blood pressure or diabetes that's not well controlled. If you had preeclampsia during a previous pregnancy — a condition that causes high blood pressure and extra protein in urine — flying may not be advised. The same is true if you're pregnant with twins or other multiples.

Tell your provider how far you are flying, as the length of the flight might make a difference. Also, be aware that some airlines may not allow pregnant people on international flights. Check with your airline before you make travel arrangements.

After 36 weeks of pregnancy, your health care provider may advise against flying. And some airlines don't allow pregnant people to fly after 36 weeks. The airline also may require a letter from your health care provider that states how far along in your pregnancy you are and whether flying is advised.

If your health care provider says it's okay for you to fly, and your plans are flexible, the best time to travel by air might be during the second trimester. The risks of common pregnancy emergencies are lowest during that time.

When you fly:

• Buckle up. During the trip, keep your seatbelt fastened when you are seated, and secure it under your belly.
• Drink plenty of fluids. Low humidity in the airplane could cause you to become dehydrated.
• Avoid gassy foods and drinks before you fly. Gases expand during flight, and that could make you uncomfortable. Examples of foods and drinks to avoid include broccoli and carbonated soda.
• Think about medical care. Plan for how you'll get obstetric care during your trip if you need it. Bring copies of your medical information in case you need care while you're away.

Blood clots

Air travel can raise the risk for blood clots in the legs, a condition called venous thrombosis. The risk is higher for pregnant people. Moving your legs may help prevent this problem. Take a walk up and down the aisle every hour during the flight. If you must remain seated, flex and extend your ankles from time to time. In general, it's best to avoid tightfitting clothing, as that can hinder blood flow. Wearing compression stockings can help with blood circulation during a long flight.

Radiation exposure linked to air travel at high altitudes isn't thought to be a problem for most people who fly during pregnancy. But pilots, flight attendants and others who fly often might be exposed to a level of radiation that raises concerns during pregnancy. If you must fly frequently during your pregnancy, talk about it with your health care provider.

Mary Marnach, M.D.

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• Allergy medications during pregnancy
• AskMayoExpert. Health considerations for air travelers: Pregnancy considerations. Mayo Clinic; 2022.
• Air Travel During Pregnancy: ACOG Practice Bulletin No. 746. American College of Obstetricians and Gynecologists. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/08/air-travel-during-pregnancy. Accessed Dec. 1, 2022.
• Ram S, et al. Air travel during pregnancy and the risk of venous thrombosis. American Journal of Obstetrics and Gynecology. 2022; doi:10.1016/j.ajogmf.2022.100751.

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• Section 6 - Medical Tourism
• Section 7 - Travel & Breastfeeding

Pregnant Travelers

Cdc yellow book 2024.

Author(s): Romeo Galang, I. Dale Carroll, Titilope Oduyebo

• The Pretravel Consultation

Infectious Disease Concerns

Environmental health concerns, transportation considerations.

Pregnancy can cause physiologic changes that require special consideration during travel. With careful preparation, however, most pregnant people can travel safely.

Pretravel Consultation

The pretravel consultation and evaluation of pregnant travelers ( Box 7-01 ) should begin with a careful medical and obstetric history, specifically assessing gestational age and the presence of factors and conditions that increase risk for adverse pregnancy outcomes. A visit with an obstetric health care provider also should be a part of the pretravel assessment to ensure routine prenatal care and identify any potential problems. Instruct pregnant travelers to carry with them a copy of their prenatal records and physician’s contact information.

Review the pregnant person’s travel itinerary, including accommodations, activities, and destinations, to guide pretravel health advice. Discourage pregnant travelers from undertaking unaccustomed vigorous activity. Swimming and snorkeling during pregnancy generally are safe, but falls during waterskiing have been reported to inject water into the birth canal. Most experts advise against scuba diving for pregnant people because of risk for fetal gas embolism during decompression (see Sec. 4, Ch. 4, Scuba Diving: Decompression Illness & Other Dive-Related Injuries ). Riding animals, bicycles, or motorcycles presents risks for abdominal trauma.

Educate pregnant people on how to avoid travel-associated risks, manage minor pregnancy discomforts, and recognize more serious complications. Advise pregnant people to seek urgent medical attention if they experience contractions or premature labor; symptoms of deep vein thrombosis (e.g., unusual leg swelling and pain in the calf or thigh) or pulmonary embolism (e.g., unusual shortness of breath); dehydration, diarrhea, or vomiting; severe pelvic or abdominal pain; symptoms of preeclampsia (e.g., severe headaches, nausea and vomiting, unusual swelling, vision changes); prelabor rupture of the membranes; or vaginal bleeding.

Box 7-01 Pretravel consultation for pregnant travelers: a checklist for health care providers

☐ Review vaccination history (e.g., COVID-19, hepatitis A, hepatitis B, measles, pertussis, rubella, varicella, tetanus) and update vaccinations as needed (see text for contraindications during pregnancy)

☐ Policies and paperwork

• Discuss supplemental travel insurance, travel health insurance, and medical evacuation insurance; research specific coverage information and limitations for pregnancy-related health issues
• Advise travelers to check airline and cruise line policies for pregnant travelers
• Provide letter confirming due date and fitness to travel
• Provide copy of medical records

☐ Prepare for obstetric care at destination

• Advise traveler to arrange for obstetric care at destination, as needed

☐ Review signs and symptoms requiring immediate care, including

• Contractions or preterm labor
• Deep vein thrombosis or pulmonary embolism symptoms, which include unusual swelling of leg with pain in calf or thigh, unusual shortness of breath
• Pelvic or abdominal pain
• Preeclampsia symptoms (e.g., unusual swelling, severe headaches, nausea and vomiting, vision changes)
• Rupture of membranes
• Vomiting, diarrhea, dehydration

Contraindications to Travel During Pregnancy

Absolute contraindications are conditions for which the potential harm of travel during pregnancy always outweighs the benefits of travel to the pregnant person or fetus. Relative contraindications are conditions for which travel should be avoided if the potential harm from travel outweighs its benefits ( Box 7-02 ).

Although travel is rarely contraindicated during a normal pregnancy, pregnancies that require frequent antenatal monitoring or close medical supervision might warrant a recommendation that travel be delayed. Educate pregnant travelers that the risk of obstetric complications is greatest in the first and third trimesters of pregnancy.

Box 7-02 Contraindications to travel during pregnancy

Absolute contraindications.

• Abruptio placentae
• Active labor
• Incompetent cervix
• Premature labor
• Premature rupture of membranes
• Suspected ectopic pregnancy
• Threatened abortion / vaginal bleeding
• Toxemia, past or present

RELATIVE CONTRAINDICATIONS

• Abnormal presentation
• Fetal growth restriction
• History of infertility
• History of miscarriage or ectopic pregnancy
• Maternal age <15 or >35 years
• Multiple gestation
• Placenta previa or other placental abnormality

Planning for Emergency Care

Obstetric emergencies are often sudden and life-threatening. Advise all pregnant travelers (but especially those in their third trimester or otherwise at high risk) to identify, in advance, international medical facilities at their destination(s) capable of managing complications of pregnancy, delivery (including by caesarean section), and neonatal problems. Counsel against travel to areas where obstetric care might be less than the standard at home.

Many health insurance policies do not cover the cost of medical treatment for pregnancy or neonatal complications that occur overseas. Pregnant people should strongly consider purchasing supplemental travel health insurance to cover pregnancy-related problems and care of the neonate, as needed. In addition, pregnant travelers should consider medical evacuation insurance coverage in case of pregnancy-related complications (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance ).

Medications

Over-the-counter drugs and nondrug remedies can help a pregnant person travel more comfortably. For instance, pregnant people can safely use a mild bulk laxative for constipation. In addition, several simple available remedies are effective in relieving the symptoms of morning sickness. Nonprescription remedies include ginger, available as a powder that can be mixed with food or drinks (e.g., tea), and as candy (e.g., lollipops). Similarly, pyridoxine (vitamin B6) is effective in reducing symptoms of morning sickness and is available in tablet form, as well as lozenges and lollipops. Antihistamines (e.g., dimenhydrinate, meclizine) often are used in pregnancy for morning sickness and motion sickness and appear to have a good safety record.

Carefully consider appropriate pain management and use of analgesics during pregnancy. Acetaminophen remains the nonopioid analgesic of choice during pregnancy. Although low-dose aspirin has been demonstrated to be relatively safe during pregnancy for certain clinical indications, it should be used cautiously. Aspirin can increase the incidence of abruption, and other anti-inflammatory agents can cause premature closure of the ductus arteriosus.

Various systems are used to classify drugs with respect to their safety in pregnancy . Refer to specific data about the effects of a given drug during pregnancy rather than depending on a classification. Counsel patients to help them make a balanced decision on the use of medications during pregnancy.

Vaccinations

In the best possible scenario, people should be up to date on routine vaccinations before becoming pregnant. The most effective way of protecting the infant against many diseases is to vaccinate the pregnant person. See a summary of current Advisory Committee on Immunization Practices (ACIP)  guidelines for vaccinating pregnant people .

Coronavirus Disease 2019

Pregnant people are more likely to become more severely ill from coronavirus disease 2019 (COVID-19) than people who are not pregnant. Having COVID-19 during pregnancy increases a person’s risk of complications that can affect their pregnancy. For these reasons, the Centers for Disease Control and Prevention (CDC) recommends that people who are pregnant, trying to get pregnant, or who might become pregnant in the future get vaccinated against COVID-19 . As of August 2022, the COVID-19 vaccines authorized or approved for use in the United States are nonreplicating vaccines that do not cause infection in the pregnant person or the fetus. Pregnant people may choose to receive any of the COVID-19 vaccines authorized or approved for use in the United States; the ACIP does not state a preference.

COVID-19 vaccination can be safely provided before pregnancy or during any trimester of pregnancy. Available vaccines are highly effective in preventing severe COVID-19, hospitalizations, and deaths; data have shown that the benefits of vaccination during pregnancy, to both the pregnant person and their fetus, outweigh any potential risks. Pregnant people might want to speak with their health care provider before making a decision about receiving COVID-19 vaccine , but a consultation is not required before vaccination. Side effects from COVID-19 vaccination in pregnant people are like those expected among nonpregnant people. Pregnant people can take acetaminophen if they experience fever or other post-vaccination symptoms.

The ACIP recommends that all people who are or who will become pregnant during the influenza season have an annual influenza vaccine using inactivated virus. Influenza vaccines can be administered during any trimester.

The safety of hepatitis A vaccination during pregnancy has not been determined; because hepatitis A vaccine is produced from inactivated virus, though, the risk to the developing fetus is expected to be low. Weigh the risk associated with vaccination against the risk for infection in pregnant people who could be at increased risk for exposure to hepatitis A virus. According to the ACIP, pregnant people traveling internationally are at risk of hepatitis A virus infection; ACIP recommends vaccination during pregnancy for nonimmune international travelers.

Limited data suggest that developing fetuses are not at risk for adverse events resulting from vaccination of pregnant people with hepatitis B vaccine (for details, see Sec. 5, Part 2, Ch. 8, Hepatitis B ). ACIP recommends vaccinating pregnant people identified as being at risk for hepatitis B virus infection during pregnancy; risk factors include >1 sex partner during the previous 6 months, being evaluated or treated for a sexually transmitted infection, recent or current injection drug use, or having a HBsAg-positive sex partner. In November 2021, ACIP recommended vaccination of all adults 19–59 years old.

Japanese Encephalitis

Data are insufficient to make specific recommendations for use of Japanese encephalitis vaccine in pregnant people (see Sec. 5, Part 2, Ch. 13, Japanese Encephalitis ).

Live-Virus Vaccines

Most live-virus vaccines, including live attenuated influenza, measles-mumps-rubella, live typhoid (Ty21a), and varicella, are contraindicated during pregnancy. Postexposure prophylaxis of a nonimmune pregnant person exposed to measles can be provided by administering measles immune globulin (IG) within 6 days of exposure; for varicella exposures, varicella-zoster IG can be given within 10 days. Advise people planning to become pregnant to wait ≥4 weeks after receiving a live-virus vaccine before conceiving.

Yellow Fever

Yellow fever vaccine is the exception to the rule about live-virus vaccines being contraindicated during pregnancy. ACIP considers pregnancy a precaution (i.e., a relative contraindication) for yellow fever vaccine. If travel is unavoidable, and the risk for yellow fever virus exposure outweighs the vaccination risk, it is appropriate to recommend vaccination. If the risks for vaccination outweigh the risks for yellow fever virus exposure, consider providing a medical waiver to the pregnant traveler to fulfill health regulations. Because pregnancy might affect immune responses to vaccination, consider performing serologic testing to document an immune response to yellow fever vaccine. Furthermore, if a person was pregnant (regardless of trimester) when they received their initial dose of yellow fever vaccine, they should receive 1 additional dose before they are next at risk for yellow fever virus exposure (see Sec. 5, Part 2, Ch. 26, Yellow Fever ).

Meningococcal

According to the ACIP , pregnant (and lactating) people should receive quadrivalent meningococcal vaccine, if indicated. Meningococcal vaccine might be indicated for international travelers, depending on risk for infection at the destination (see Sec. 5, Part 1, Ch. 13, Meningococcal Disease ).

No adverse events linked to inactivated polio vaccine (IPV) have been documented among pregnant people or their fetuses. Vaccination of pregnant people should be avoided, however, because of theoretical concerns. IPV can be administered in accordance with the recommended immunization schedule for adults if a pregnant person is at increased risk for infection and requires immediate protection against polio (see Sec. 5, Part 2, Ch. 17, Poliomyelitis ).

Administer rabies postexposure prophylaxis with rabies immune globulin and vaccine after any moderate- or high-risk exposure to rabies; consider preexposure vaccine for travelers who have a substantial risk for exposure (see Sec. 5, Part 2, Ch. 18, Rabies ).

Tetanus-Diphtheria-Pertussis

Tetanus, diphtheria, and acellular pertussis vaccine (Tdap) should be given during each pregnancy irrespective of a person’s history of receiving the vaccine previously. To maximize maternal antibody response and passive antibody transfer to the infant, optimal timing for Tdap administration is between 27 and 36 weeks’ gestation (earlier during this time frame is preferred), but it may be given at any time during pregnancy.

Malaria Prophylaxis

Malaria, caused by Plasmodium spp. parasites transmitted by mosquitoes, can be much more serious in pregnant than in nonpregnant people and is associated with high risks of illness and death for both mother and fetus. Malaria in pregnancy can be characterized by heavy parasitemia, severe anemia, and profound hypoglycemia, and can be complicated by cerebral malaria and acute respiratory distress syndrome. Placental sequestration of parasites might result in fetal loss due to abruption, premature labor, or miscarriage. An infant born to an infected mother is apt to be of low birth weight, and, although rare, congenital malaria is possible.

Because no prophylactic regimen provides complete protection, pregnant people should avoid or delay travel to malaria-endemic areas. If travel is unavoidable, the pregnant person should take precautions to avoid mosquito bites and use an effective prophylactic regimen.

Chloroquine is the drug of choice for pregnant travelers going to destinations with chloroquine-sensitive Plasmodium spp., and mefloquine is the drug of choice for pregnant travelers going to destinations with chloroquine-resistant Plasmodium spp. Doxycycline is contraindicated because of teratogenic effects on the fetus after the fourth month of pregnancy. Primaquine is contraindicated in pregnancy because the infant cannot be tested for glucose-6-phosphate dehydrogenase deficiency, putting the infant at risk for hemolytic anemia. Atovaquone-proguanil is not recommended because of lack of available safety data. A list of the available antimalarial drugs and their uses and contraindications during pregnancy can be found in Sec. 5, Part 3, Ch. 16, Malaria .

Travel Health Kits

In addition to the recommended travel health kit items for all travelers (see Sec. 2, Ch. 10, Travel Health Kits ), pregnant travelers should pack antacids, antiemetic drugs, graduated compression stockings, hemorrhoid cream, medication for vaginitis or yeast infection, prenatal vitamins, and prescription medications. Encourage pregnant travelers to consider packing a blood pressure monitor if travel will limit access to a health center where blood pressure monitoring is available.

Respiratory and urinary infections and vaginitis are more likely to occur and to be more severe during pregnancy. Pregnant people who develop travelers’ diarrhea or other gastrointestinal infections might be more vulnerable to dehydration than nonpregnant travelers. Stress the need for strict hand hygiene and food and water precautions (see Sec. 2, Ch. 8, Food & Water Precautions ). Drinking bottled or boiled water is preferable to chemically treated or filtered water. Pregnant people should not consume water purified by iodine-containing compounds because of potential effects on the fetal thyroid (see Sec. 2, Ch. 9, Water Disinfection ).

As mentioned previously, pregnant people are at increased risk for severe COVID-19–associated illness (e.g., requiring invasive ventilation or extracorporeal membrane oxygenation) and death compared with people who are not pregnant. Underlying medical conditions (e.g., chronic kidney disease, diabetes, obesity) and other factors (e.g., age, occupation) can further increase a pregnant person’s risk for developing severe illness. Additionally, pregnant people with COVID-19 are at greater risk for preterm birth and other adverse outcomes.

Pregnant people, recently pregnant people, and those who live with or visit them should take steps to protect themselves from getting COVID-19. CDC recommends that people (including those who are pregnant) not travel internationally until they are up to date with their COVID-19 vaccines . Additional information for international travelers is available at CDC's International Travel website.

Hepatitis A and hepatitis E are both spread by the fecal–oral route (see Sec. 5, Part 2, Ch. 7, Hepatitis A , and Sec. 5, Part 2, Ch. 10, Hepatitis E ). Hepatitis A has been reported to increase the risk for placental abruption and premature delivery. Hepatitis E is more likely to cause severe disease during pregnancy and could result in a case-fatality rate of 15%–30%; when acquired during the third trimester, hepatitis E is also associated with fetal complications and fetal death.

Listeriosis & Toxoplasmosis

Listeriosis and toxoplasmosis (see Sec. 5, Part 3, Ch. 23, Toxoplasmosis ) are foodborne illnesses of particular concern during pregnancy because the infection can cross the placenta and cause spontaneous abortion, stillbirth, or congenital or neonatal infection. Warn pregnant travelers to avoid unpasteurized cheeses and uncooked or undercooked meat products. Risk for fetal infection increases with gestational age, but severity of infection is decreased.

Other Parasitic Infections & Diseases

Parasitic infections and diseases can be a concern, particularly for pregnant people visiting friends and relatives in low- and middle-income countries. In general, intestinal helminths rarely cause enough illness to warrant treatment during pregnancy. Most, in fact, can be addressed safely with symptomatic treatment until the pregnancy is over. On the other hand, protozoan intestinal infections (e.g., Cryptosporidium , Entamoeba histolytica , Giardia ) often do require treatment. These parasites can cause acute gastroenteritis, severe dehydration, and chronic malabsorption resulting in fetal growth restriction. E. histolytica can cause invasive disease, including amebic liver abscess and colitis. Pregnant people also should avoid bathing, swimming, or wading in freshwater lakes, rivers, and streams that can harbor the parasitic worms (schistosomes) that cause schistosomiasis (see Sec. 5, Part 3, Ch. 20, Schistosomiasis ).

Travelers’ Diarrhea

The treatment of choice for travelers’ diarrhea is prompt and vigorous oral hydration; azithromycin or a third-generation cephalosporin may, however, be given to pregnant people if clinically indicated. Avoid use of bismuth subsalicylate because of the potential impact of salicylates on the fetus. In addition, fluoroquinolones are contraindicated in pregnancy due to toxicity to developing cartilage, as noted in experimental animal studies.

Vectorborne Infections

Pregnant people should avoid mosquito bites when traveling in areas where vectorborne diseases are endemic. Preventive measures include use of Environmental Protection Agency–registered insect repellants , protective clothing, and mosquito nets (see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods ). For details on yellow fever vaccine and malaria prophylaxis during pregnancy, see above.

Zika virus is spread primarily through the bite of an infected Aedes mosquito ( Ae. aegypti and Ae. albopictus ) but can also be sexually transmitted. The illness associated with Zika can be asymptomatic or mild; some patients report acute onset of conjunctivitis, fever, joint pain, and rash that last for several days to a week after infection.

Birth defects caused by Zika virus infection during pregnancy include brain, eye, and neurodevelopmental abnormalities. Because of the risk for birth defects, CDC recommends pregnant people avoid travel to areas with a Zika outbreak, and, for the duration of the pregnancy, to avoid sex or use condoms with anyone who has traveled to a risk area.

Advise pregnant people considering travel to areas with Zika to carefully assess the risks of Zika infection during pregnancy; provide information about prevention strategies, signs and symptoms, and the limitations of Zika testing. Pregnant people should strictly follow steps to prevent mosquito bites and sexual transmission. See additional information, including the most current list of countries and territories where Zika is active . Guidance for pregnant people can be found on the CDC Zika website .

Pregnant people should be aware of specific current environmental issues in their international destinations (e.g., natural disasters, special events or gatherings, travel warnings). More information can be found at the CDC Travelers’ Health website and on the destination pages of the US Department of State website.

Air Quality

Air pollution causes more health problems during pregnancy because ciliary clearance of the bronchial tree is slowed, and mucus is more abundant. For more details on traveling to destinations where air quality is poor, see Sec. 4, Ch. 3, Air Quality & Ionizing Radiation .

Extremes of Temperature

Body temperature regulation is not as efficient during pregnancy, and temperature extremes can create more physiological stress on the pregnant person (see Sec. 4, Ch. 2, Extremes of Temperature ). In addition, increases in core temperature (e.g., heat exhaustion, heat stroke), might harm the fetus. The vasodilatory effect of a hot environment and dehydration might cause fainting. For these reasons, then, encourage pregnant travelers to seek air-conditioned accommodations and restrict their level of activity in hot environments. If heat exposure is unavoidable, the duration should be as short as possible to prevent an increase in core body temperature. Pregnant travelers should take measures to avoid dehydration and hyperthermia.

High Elevation Travel

Pregnant people should avoid activities at high elevation unless they have trained for and are accustomed to such activities; those not acclimated to high elevation might experience breathlessness and palpitations. The common symptoms of acute mountain sickness (insomnia, headache, and nausea) frequently are associated with pregnancy, and it might be difficult to distinguish the cause of the symptoms. Most experts recommend a slower ascent with adequate time for acclimatization. No studies or case reports show harm to a fetus if the mother travels briefly to high elevations during pregnancy; recommend that pregnant people not sleep at elevations >12,000 ft (≈3,600 m) above sea level, if possible. Probably the greatest concern is that high-elevation destinations often are inaccessible and far from medical care (see Sec. 4, Ch. 5, High Elevation Travel & Altitude Illness ).

Advise pregnant people to follow safety instructions for all forms of transport and to wear seat belts, when available, on all forms of transportation, including airplanes, buses, and cars (see Sec. 8, Ch. 5, Road & Traffic Safety ). A diagonal shoulder strap with a lap belt provides the best protection. The shoulder belt should be worn between the breasts with the lap belt low across the upper thighs. When only a lap belt is available, pregnant people should wear it low, between the abdomen and across the upper thighs, not above or across the abdomen.

Most commercial airlines allow pregnant travelers to fly until 36 weeks’ gestation. Some limit international travel earlier in pregnancy, and some require documentation of gestational age. Pregnant travelers should check with the airline for specific requirements or guidance, and should consider the gestational age of the fetus on the dates both of departure and of return.

Most commercial jetliner cabins are pressurized to an equivalent outside air pressure of 6,000–8,000 ft (≈1,800–2,500 m) above sea level; travelers might also experience air pressures in this range during travel by hot air balloon or on noncommercial aircraft. The lower oxygen tension under these conditions likely will not cause fetal problems in a normal pregnancy. People with pregnancies complicated by conditions exacerbated by hypoxia (e.g., preexisting cardiovascular problems, sickle cell disease, severe anemia [hemoglobin <8.0 g/dL], intrauterine fetal growth restriction) could, however, experience adverse effects associated with low arterial oxygen saturation.

Risks of air travel include potential exposure to communicable diseases, immobility, and the common discomforts of flying. Abdominal distention and pedal edema frequently occur. The pregnant traveler might benefit from an upgrade in airline seating and should seek convenient and practical accommodations (e.g., proximity to the lavatory). Pregnant travelers should select aisle seating when possible, and wear loose fitting clothing and comfortable shoes that enable them to move about more easily and frequently during flights.

Some experts report that the risk for deep vein thrombosis (DVT) is 5–10 times greater among pregnant than nonpregnant people, although the absolute risk is low. To help prevent DVT, pregnant travelers should stay hydrated, stretch frequently, walk and perform isometric leg exercises, and wear graduated compression stockings (see Sec. 8, Ch. 3, Deep Vein Thrombosis & Pulmonary Embolism ).

Cosmic radiation during air travel poses little threat to the fetus but might be a consideration for pregnant travelers who fly frequently (see Sec. 9, Ch. 3, . . . perspectives: People Who Fly for a Living—Health Myths & Realities ). Older airport security machines are magnetometers and are not harmful to the fetus. Newer security machines use backscatter x-ray scanners, which emit low levels of radiation. Most experts agree that the risk for complications from radiation exposure from these scanners is extremely low.

Cruise Ship Travel

Most cruise lines restrict travel beyond 24 weeks’ gestation (see Sec. 8, Ch. 6, Cruise Ship Travel ). Cruise lines might require pregnant travelers to carry a physician’s note stating that they are fit to travel, including the estimated date of delivery. Pregnant people should check with the cruise line for specific requirements or guidance. For pregnant travelers planning a cruise, provide advice about gastrointestinal and respiratory infections, motion sickness (see Sec. 8, Ch. 7, Motion Sickness ), and the risk for falls on a moving vessel, as well as the possibility of delayed care while at sea.

The following authors contributed to the previous version of this chapter: Diane F. Morof, I. Dale Carroll

Bibliography

Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al.; PregCOV-19 Living Systematic Review Consortium. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 2020;370:m3320.

Bisson DL, Newell SD, Laxton C; on behalf of the Royal College of Obstetricians and Gynaecologists. Antenatal and postnatal analgesia. BJOG. 2018;126(4):114–24.

Centers for Disease Control and Prevention. Guidelines for vaccinating pregnant women. Atlanta: The Centers; 2014. Available from: www.cdc.gov/vaccines/pregnancy/hcp-toolkit/guidelines.html .

Dotters-Katz S, Kuller J, Heine RP. Parasitic infections in pregnancy. Obstet Gynecol Surv. 2011;66(8):515–25.

Hezelgrave NL, Whitty CJ, Shennan AH, Chappell LC. Advising on travel during pregnancy. BMJ. 2011;342:d2506.

Irvine MH, Einarson A, Bozzo P. Prophylactic use of antimalarials during pregnancy. Can Fam Physician. 2011;57(11):1279–81.

Magann EF, Chauhan SP, Dahlke JD, McKelvey SS, Watson EM, Morrison JC. Air travel and pregnancy outcomes: a review of pregnancy regulations and outcomes for passengers, flight attendants, and aviators. Obstet Gynecol Surv. 2010;65(6):396–402.

Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth defects—reviewing the evidence for causality. N Engl J Med. 2016;374(20):1981–7.

Rasmussen SA, Watson AK, Kennedy ED, Broder KR, Jamieson DJ. Vaccines and pregnancy: past, present, and future. Semin Fetal Neonatal Med. 2014;19(3):161–9.

Roggelin L, Cramer JP. Malaria prevention in the pregnant traveller: a review. Travel Med Infect Dis. 2014;12(3):229–36.

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Travel During Pregnancy

As long as there are no identified complications or concerns with your pregnancy, it is generally safe to travel during your pregnancy. The ideal time to travel during pregnancy is the second trimester .  In most cases, you are past the morning sickness of the first trimester and several weeks from the third stage of pregnancy when you are more easily fatigued .

Is it safe to travel during pregnancy?

Traveling by air is considered safe for women while they are pregnant; however, the following ideas might make your trip safer and more comfortable.

• Most airlines allow pregnant women to travel through their eighth month. Traveling during the ninth month is usually allowed if there is permission from your health care provider.
• Most airlines have narrow aisles and smaller bathrooms, which makes it more challenging to walk and more uncomfortable when using the restroom. Because of potential turbulence that could shake the plane, make sure you are holding on to the seatbacks while navigating the aisle.
• You may want to choose an aisle seat which will allow you to get up more easily to reach the restroom or just to stretch your legs and back.
• Travel on major airlines with pressurized cabins and avoid smaller private planes. If you must ride in smaller planes, avoid altitudes above 7,000 feet.
• Although doubtful, the risk of DVT can be further reduced by wearing compression stockings.

The Royal College of Obstetricians and Gynaecologists and the International Air Travel Association recommend that expecting mothers in an uncomplicated pregnancy avoid travel from the 37th week of pregnancy through birth. Avoiding travel from 32 weeks through birth is recommended for women who have complicated pregnancies with risk factors for premature labor, such as mothers carrying multiples.

Risk factors that warrant travel considerations include the following:

• Severe anemia
• Cardiac disease
• Respiratory disease
• Recent hemorrhage
• Current or recent bone fractures

Traveling by Sea During Pregnancy

Traveling by sea is generally safe for women while they are pregnant; the motion of the boat may accentuate any morning sickness or make you feel nauseous all over again. There are a few considerations to make your trip safer and more comfortable:

• Check with the cruise line to ensure that there is a health care provider on board in case there are any pregnancy complications .
• Review the route and port-of-calls to identify if there is access to any medical facilities if needed.
• Make sure any medications for seasickness are approved for women who are pregnant and that there is no risk to the developing baby.
• Seasickness bands use acupressure points to help prevent upset stomach and maybe a good alternative to medication.

International Travel During Pregnancy

Traveling overseas has the same considerations that local or domestic travel has, but it also has additional concerns that you need to know about before making an international trip. The information below is provided to help you assess whether an international trip is good for you at this time:

• It is important to talk with your health care provider before you take a trip internationally to discuss safety factors for you and your baby.
• Discuss immunizations with your health care provider and carry a copy of your health records with you.
• With international travel, you may be exposed to a disease that is rare here in the United States but is common in the country you visit.
• Contact the Centers for Disease Control and Prevention at (800) 311-3435 or visit their website at www.cdc.gov to receive safety information along with immunization facts related to your travels.
• Diarrhea is a common concern when traveling overseas because you may not be used to the germs and organisms found in the food and water of other countries. This can lead to a problem of dehydration .

Here are some tips to avoid diarrhea and help keep you safe:

• Drink plenty of bottled water
• Used canned juices or soft drinks as alternatives
• Make sure the milk is pasteurized
• Avoid fresh fruits and vegetables unless they have been cooked or can be peeled (such as an orange or a banana)
• Make certain that all meat and fish has been cooked completely; if you are unsure, do not eat it

Travel Tips During Pregnancy

Whether you are going by car, bus, or train, it is generally safe to travel while you are pregnant; however, there are some things to consider that could make your trip safer and more comfortable.

• It is essential to buckle-up every time you ride in a car. Make sure that you use both the lap and shoulder belts for the best protection of you and your baby.
• Keep the airbags turned on. The safety benefits of the airbag outweigh any potential risk to you and your baby.
• Buses tend to have narrow aisles and small restrooms. This mode of transportation can be more challenging.  The safest thing is to remain seated while the bus is moving. If you must use the restroom, make sure to hold on to the rail or seats to keep your balance.
• Trains usually have more room to navigate and walk. The restrooms are usually small. It is essential to hold on to rails or seat backs while the train is moving.
• Try to limit the amount of time you are cooped up in the car, bus, or train. Keep travel time around five to six hours.
• Use rest stops to take short walks and to do stretches to keep the blood circulating.
• Dress comfortably in loose cotton clothing and wear comfortable shoes.
• Take your favorite pillow.
• Plan for plenty of rest stops, restroom breaks and stretches.
• Carry snack foods with you.
• If you are traveling any distance, make sure to carry a copy of your prenatal records.
• Enjoy the trip.

Want to Know More?

• How to Treat Jet Lag Naturally During Pregnancy

Compiled using information from the following sources:

1. Planning Your Pregnancy and Birth Third Ed. The American College of Obstetricians and Gynecologists, Ch. 5. William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 8.

2. Royal College of Obstetricians and Gynaecologists, Air Travel and Pregnancy (Scientific Impact Paper No. 1), https://www.rcog.org/uk, May 22, 2013.

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Editors note: This guide has been updated with the latest information.

During pregnancy, seemingly harmless things like eating deli meat and cleaning your cat's litter box are suddenly off-limits, along with more obvious restrictions on sports like skiing and scuba diving.

But what about "grey area" activities like flying in an airplane?

There's no single set of guidelines governing air travel during pregnancy and every airline has different restrictions, timelines and requirements. Some airlines may also require a medical certificate from a primary attending doctor or midwife for air travel during the final months of pregnancy, though even that varies, with U.S. airlines typically offering more flexibility than international carriers.

For more TPG news delivered each morning to your inbox, sign up for our daily newsletter .

In the absence of clear guidelines, TPG turned to Dr. Nithya Gopal , a board-certified OB-GYN physician and the Director of OB-GYN services at Viva Eve in New York City, for her expert recommendations on safe air travel during pregnancy.

Here's what she had to say:

Is it safe to fly when you are pregnant?

There is no evidence of adverse pregnancy outcomes due to flying, according to Dr. Gopal.

"The general consensus is that it is safest to fly in the first and second trimesters," Dr. Gopal told The Points Guy. "While the first and third trimesters tend to be when the most obstetric emergencies are going to happen, I personally become more cautious with my patients after 32 weeks because of the increased risk for premature labor and the possibility of needing urgent medical attention when you are in the sky."

The most important thing you can do, no matter how far along you are in your pregnancy, is to consult with your healthcare provider before flying.

"Any time you are planning to fly during pregnancy , you should be having that conversation," Dr. Gopal said. Your provider will be familiar with any safety precautions you should take to ensure a safe and healthy flight.

Related: Guide to flying in each trimester of pregnancy

The airline you are flying may have its own cutoff, so you will want to confirm with it beforehand whether you will be allowed to fly if you are in (or nearing) your third trimester. We've included a chart below that outlines the rules for most major airline carriers.

What can you do to stay comfortable on a flight?

When you factor in morning sickness and general pregnancy discomfort with the increased risk for blood clots that all fliers need to be aware of, flying during pregnancy can be uncomfortable even when it is deemed safe.

Dr. Gopal shared her recommendations for addressing these common issues when you take to the (baby-) friendly skies during pregnancy. Her number one tip for staying comfortable while in flight is to wear compression socks to help maintain blood flow and reduce swelling in the legs.

In addition, "I also tell my patients to get up and move at least every hour when they are on the plane," Dr. Gopal said.

To prevent clotting, "some doctors may also prescribe a low-dose aspirin," she added. "It isn't something that is recommended by the American College of Obstetricians and Gynecologists (ACOG), but it isn't harmful, either."

If it's nausea or acid reflux that ail you, there are medications generally considered safe that you can take to alleviate your symptoms. These would be the same ones prescribed by your doctor for morning sickness, so speak with your provider before your flight to ensure you have what you need at the ready.

Dr. Gopal also advises wearing loose, unrestrictive clothing (along with your seatbelt, or course) and drinking extra fluids to counteract the pressurized air in the cabin and keep you hydrated.

"Over-the-counter Gas-X may also help with bloating that can happen as a result of the pressurized air," Dr. Gopal said.

Related: What happens when a baby is born in flight?

Must you speak with your healthcare provider before flying?

Even if your pregnancy is considered low-risk, it's always a smart idea to speak with your healthcare provider before flying. "There are a number of potential risks that go along with flying during pregnancy and those risks can change from week to week and month to month, so it's important to have that honest conversation with your doctor," Dr. Gopal said.

Related: Things You Should Do Before, During and After Flying to Stay Healthy

There are certain pregnancy conditions that may make flying more risky or unadvisable. If you are hypertensive, asthmatic or prone to clotting disorders, it's even more critical to speak with your doctor before flying.

Airline policies differ, but if you need documentation, it never hurts to include enough detail to satisfy the most stringent airline requirements.

"As with many things related to air travel, it's better to be safe than sorry," Dr. Gopal said. "It's definitely worth it, and sometimes necessary, to have medical documentation from your provider's office."

A thorough medical certificate or waiver should state:

• The number of weeks of pregnancy.
• The estimated delivery date.
• Whether the pregnancy is single or multiple.
• Whether there are any complications.
• That you are in good health and fit to travel through the date of your final flight.

Additionally, the certificate should be:

• Written on official clinic or hospital letterhead if possible.
• Signed by the doctor or attending midwife.
• Be dated no later than 72 hours before the departure date.
• Be written in clear, simple English.

Carry this certificate with you on your flight. Some airlines won't ask to see it, but others will. Some airlines also may have their own documentation requirements. See the chart below to find out which airlines require it.

Airline policies for pregnant women

Bottom line.

Even though it may be deemed safe, flying during pregnancy can be uncomfortable — and it is perfectly acceptable to implement your own cutoff for flying with your baby bump in tow. The majority of the time, though, flying is perfectly safe during pregnancy, providing that you follow the guidelines of the airline and your healthcare provider. Read on to learn more about traveling before, during and after pregnancy:

• What to expect in every trimester of pregnancy
• 4 tips for planning travel while planning a pregnancy
• Babymoon boom! These are the top 10 spots for a US getaway before the baby comes
• Flying with a baby checklist

Additional reporting by Katherine Fan and Tarah Chieffi.

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Dos and Don'ts of Traveling While Pregnant

Is it safe to travel while you're pregnant? Should you be taking a car, train or bus? OB/GYN Dr. Jennifer Feige from University of Utah Health shares some things you should consider before you go on that next trip while pregnant to make sure both Mom and baby are safe.

Episode Transcript

Interviewer: Pregnant and traveling? What you need to know, that's next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Jennifer Feige is an OB/GYN at University of Utah Health. If you have a patient that's pregnant and thinking about taking a trip or has one scheduled, what kind of advice do you normally give them?

Dr. Feige: I usually break it down into thinking about three different categories. So first of all, when during the pregnancy are they traveling? Where are they traveling to? And then finally how are they arriving at their destination?

To begin with, when we talk about when during the pregnancy is one traveling, while there is no contraindication to travel during any trimester, most commonly if something were to happen during a pregnancy it would occur during the first and/or third trimester. So the ideal time for travel would be during the second trimester, which is between 14 and 28 weeks gestational age. The first trimester carries risks of miscarriage, vaginal bleeding, as well as cramping, and then the third trimester, as you get closer to term, once again, there are increased risks not only with bleeding and/or leakage of fluid but actually going into labor and having a baby. It's always best to be home closer to a hospital and your known OB/GYN as well as with records prior to giving birth on the road.

Interviewer: So you would recommend if you really were concerned, second trimester would be about the best, but as you said before you're all right first or third as well.

Dr. Feige: Exactly. The one contraindication that does come up is some airlines have strict policy of not traveling once you are full term, so after 37 weeks, but otherwise there's no strict contraindication.

Interviewer: And why is that?

Dr. Feige: Once again, just risk of labor when you're in the air -- your water breaking, you're bleeding, you're contracting, and then a baby is born.

Interviewer: Okay, yeah, it's just more of an inconvenience that they would have to deal with that.

Dr. Feige: Yeah, emergency landing of the flight, putting other passengers at risk.

Interviewer: Yeah, sure, okay, fair enough.

Dr. Feige: And maybe not having the team ready to deal with a newborn if for some reason there were another complication.

Interviewer: All right, so that covers the when component. What about the second component which is where?

Dr. Feige: Where, a lot of people these days are more into more exotic travel which is very romantic. We break it down basically into whether you are traveling to a developed country and/or a developing country. Developed country carries fewer risks. Developing does carry more risks because you have to think about where your water is coming from, some preparation of food. But, as long as you're in a developed country there are minimal risks.

The exception to that of course is we've all heard of Zika virus which is within the news, that being in South America, Central America and then parts of North America as well. Zika is an entire separate conversation. But if for some reason you were to travel in areas with Zika we, (a) discourage it in general, (b) if you do opt to go there, use protection. That means covering extremities, sleeping under nets to avoid mosquitoes, using DEET to specifically avoid any bites.

If for some reason you and your partner do travel there and your partner becomes infected, we also encourage condoms times six months because it can be transmitted through sexual intercourse as well. We do offer screening if you were in one of the Zika exposed areas. Here at the University of Utah we can screen for that.

Other contraindications or other things to think about when we talk about developing countries like I alluded to was where the water is coming from. If it is not bottled water, we recommend boiling water for at least a minute prior to consumption. That includes brushing your teeth with bottled water, any type of ingestion at all because water can carry risks of bacteria or viruses. Mainly we think about Hepatitis A when you're traveling to developing countries. Additionally, other things that we talk about is washing your fruits and vegetables, making sure you know how they're prepared, making sure things are well cooked, just once again to decrease your risk of viral or bacteria contamination.

Interviewer: So washing those fruits and vegetables if you're in an area . . .

Dr. Feige: In your clean water with your soap.

Interviewer: Okay, your bottled water.

Dr. Feige: Yes.

Interviewer: Just want to double check that.

Dr. Feige: Not dousing it in the sink. The one other thing we talk about even when you're traveling in developed countries is pasteurization. There is a bacteria called Listeria which even is found here in the United States. You always want to verify that all of your cheeses specifically are pasteurized, not eating deli meats that have been sitting out an extended period of time, or any mayonnaise-type dish that's been on the counter for an extended period of time.

Interviewer: All right, so maybe a trip to France and those exotic cheeses you might want to avoid possibly if they're not pasteurized.

Dr. Feige: Make sure they're pasteurized, exactly.

Interviewer: All right. We've covered the when and the where. The how are you getting there, what are the concerns there?

Dr. Feige: We'll focus on traveling by car, traveling by airplane, and then finally traveling by boat and/or taking that cruise. Really when it comes to car travel there is nothing to be too concerned about. If you obviously are extended period of time, over five hours in the car, if you're making a gas stop we would encourage getting out, stretching those legs and moving around.

It sort of translates into air travel as well. A lot of folks are concerned about DVTs which can be outside of pregnancy, however the physiology during pregnancy increases this risk as well. We usually recommend compression stockings on flights, frequent ambulation, good hydration and wearing loose fitting clothing just to promote general circulation.

Other questions that often come up when we talk about air travel is exposure to radiation. They've done numerous studies on this, and the F.A.A. actually has a tool where you can evaluate your overall exposure to cosmic radiation. Even with the longest flights, they expect that you're only getting about 15% of your max dose. Obviously, airline attendants or people who are frequently in the air would be an outlier here where they could use the F.A.A. tool to be an aid to them.

Finally, the other travel we are talking about is a cruise and/or being on a boat. Things to think about with both travel by water as well as by air is always anti-emetics. Obviously, nausea and vomiting is quite common in early pregnancy. You always want to have your medications with you. Specifically on cruises there has been an association with norovirus which is found on some cruise lines. It causes nausea, vomiting and diarrhea and can be disruptive obviously to a pregnancy and make you feel terrible and can have long lasting effects. If for some reason there were an outbreak on your cruise ship, they would notify you and you would want to definitely let your OB/GYN be aware of that.

Interviewer: Have you ever had any patients that have actually cancelled cruises or . . .

Dr. Feige: Absolutely.

Interviewer: . . . cancelled trips because of a pregnancy?

Dr. Feige: Yeah. That's a pretty common question for us to actually have to fill out a letter saying yes indeed you are pregnant. It happens during ski season quite often as well, needing a letter from us proving that you're pregnant in order to get a reimbursement.

Interviewer: Got you, got you. Any other final thoughts on it? I think you covered very well. It sounds like there are some very practical health concerns. It sounds like there's also some just a lot of comfort concerns as well.

Dr. Feige: Yeah. Once again, overall it's safe to travel during pregnancy. Once you're full term, we encourage you staying close to home, your hospital and your OB/GYN. But otherwise I think it's awesome to get out there and explore.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: May 22, 2019 originally published: June 1, 2017

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9 Tips for Traveling While Pregnant

An ob-gyn shares advice about traveling while pregnant and what you can do to stay safe..

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For many, the holiday season is a time to travel and gather with family and friends. For expectant mothers, holiday travel, coupled with the ongoing challenges posed by the flu, RSV (respiratory syncytial virus), and COVID-19, can introduce a unique set of considerations and uncertainties. Traveling while pregnant may require some extra precautions to ensure their comfort and safety as well as the baby’s safety.

“For those with a low-risk pregnancy, travel is generally considered safe,” says Dr. Cassandra Simmons , division chief of General Obstetrics & Gynecology at NewYork-Presbyterian Westchester. “Most patients should feel comfortable benefiting from the positive aspects of travel during holidays — by car or by plane — and be able to enjoy their time with friends and family.”

Health Matters spoke with Dr. Simmons to learn what advice she has for people traveling while pregnant.

Dr. Cassandra Simmons

1. Check in with your doctor before traveling.

Travel is not recommended for those with certain complications, such as preeclampsia , preterm labor, or pre-labor rupture of membranes (PROM).

According to Dr. Simmons, there may be slightly higher risk associated with traveling in the first trimester (when there is a greater risk of bleeding) and the third trimester (when you’re closer to delivery). Most doctors advise a pregnant person not to fly by commercial flight after 36 weeks of pregnancy. In fact, most airlines restrict air travel for pregnant people if they are close to their due date. “As one approaches their due date, the risk of labor exists, and medical care in flight is limited or not available at all,” says Dr. Simmons.

2. Plan for unexpected situations.

Locate the closest obstetric healthcare provider and hospital, regardless of where you’re traveling. “When traveling domestically and internationally, you should ensure that there are options for obstetric care near your destination so that you have a place to go if you experience unexpected symptoms related to your pregnancy while traveling,” says Dr. Simmons.

3. Stay up to date on vaccinations.

Make sure you’re up to date on your flu and COVID-19 vaccines. If you plan to travel internationally, keep in mind that some countries require specific vaccines. While some vaccines are safe during pregnancy, others may not be. “Communicate with your provider as to what vaccines are recommended based on the country to which you plan to travel,” says Dr. Simmons.

4. Take extra precautions when traveling internationally.

It’s best to avoid areas with a high risk of infectious diseases — such as malaria or Zika, two mosquito-borne diseases. Check the Centers for Disease Control and Prevention (CDC) website for current information on countries where Zika and malaria are reported. Dr. Simmons reminds pregnant people that “the main way to mitigate risk with regard to malaria and Zika is to avoid infection altogether.”

If you absolutely must travel to areas where malaria and Zika are reported, you will need to use long-acting insect repellents that are safe for use while pregnant, like EPA-registered bug spray with DEET, picaridin, IR3535, or oil of lemon eucalyptus. Wear long-sleeved shirts and pants to protect against mosquito bites. If you’re going to a malaria-endemic area, your doctor will prescribe anti-malarial pills that are safe during pregnancy.

If you’re in a country where tap water is unsafe to drink, remember to stick with bottled water — even for things like brushing your teeth — to reduce the risk of gastrointestinal (GI) infection.

5. Wear your seat belt low and snug across your hips, not over your belly.

“For comfort and safety, avoid placing your seat belt on top of your pregnant abdomen,” says Dr. Simmons. It should be worn under your belly, just above your hips.

6. If you’re on a long flight or long car ride, get up and move often to help prevent blood clots.

During pregnancy, you are at an increased risk of developing what is called deep vein thrombosis (a blood clot in a deep vein in the body, like in the leg). Sitting for too long, as during a car or plane ride, can exacerbate blood clots. “Avoid sitting or standing in one position for extended periods,” explains Dr. Simmons. Anything you can do to improve blood flow helps. For flights, stand and walk up and down the aisle of the plane every hour. Choosing an aisle seat may make it easier to get up often. For long car rides, try and stop every hour to stretch your legs. If you can’t get up and walk around, “even calf raises in your seat help with circulation when you are sedentary during travel,” says Dr. Simmons.

“Wearing compression socks is another way to promote circulation while on a long trip,” adds Dr. Simmons. These tight-fitting socks reach up to the knees and help with blood flow and circulation.

"Most patients should feel comfortable benefiting from the positive aspects of travel during holidays — by car or by plane — and be able to enjoy their time with friends and family." — Dr. Cassandra Simmons

7. Be prepared with comfortable clothing, snacks, water, and anti-nausea medicines.

Whether you have a two-hour drive or a six-hour flight ahead of you, wear comfortable clothing and shoes. Keep snacks and water on hand as well, “to stay hydrated and keep up with the metabolic demands of being pregnant,” says Dr. Simmons. And if you’re feeling nauseous or have GI discomfort while traveling, Reglan, Dramamine, and Imodium are considered safe to take while pregnant.

8. Mask up and use hand sanitizer.

“I advise my pregnant patients to wear a mask when traveling or when in the presence of large crowds, as an added precaution for safety for themselves and their unborn babies,” says Dr. Simmons. Because COVID-19, RSV, and the flu are all airborne viruses — meaning they spread through tiny respiratory droplets in the air — wearing a mask adds a layer of protection. You may also want to ask family members, friends, and loved ones to take a COVID-19 test prior to large gatherings.

And don’t forget to wash your hands and use hand sanitizer often. Keep sanitizer handy, especially if you are traveling with young children. Keep their hands sanitized as well to help keep your family safe.

9. Upon arrival, avoid any unsafe activities.

“It’s important that you enjoy your planned activities, but try and avoid adventures that may significantly increase your risk of trauma while pregnant,” says Dr. Simmons. For example, if you’re going to an amusement park or participating in an activity that could put you at risk of falling or for sudden jerky movements (like skiing or other high-impact sports), it’s important to proceed cautiously. Stick to lower-impact exercises and sports like jogging, walking, or swimming.

Cassandra Blot Simmons, M.D. , is chief of the Division of General Obstetrics & Gynecology at NewYork-Presbyterian Westchester and NewYork-Presbyterian/Columbia University Irving Medical Center. She is also an assistant professor of obstetrics and gynecology at Columbia University Vagelos College of Physicians and Surgeons. Dr. Simmons specializes in women’s gynecological health and obstetrics care before, during, and after pregnancy.

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Flying While Pregnant? Check Out the Policies on 25 Global Airlines

In the absence of obstetric or medical complications, occasional air travel during pregnancy is generally safe, according to the American College of Obstetrics and Gynecology  (ACOG). Like other travelers, pregnant women should use seat belts while seated. 

Most commercial airlines allow pregnant women to fly up to 36 weeks of gestation, with some restrictions on international flights. 

ACOG does not recommend air travel for pregnant women with medical or obstetric conditions that may be exacerbated by flight or that could require emergency care. It advises checking flight durations when planning travel and that the most common obstetric emergencies occur in the first and third trimesters.

Once aboard a flight, conditions including changes in cabin pressure and low humidity, coupled with the physiologic changes of pregnancy, do result in adaptations, including increased heart rate and blood pressure, reports ACOG. And those traveling on long-haul flights face the risks associated with immobilization and low cabin humidity. This can cause issues such as lower extremity edema and venous thrombotic events.

ACOG recommends preventive measures to minimize these risks, including the use of support stockings, regular movement of the lower extremities, avoid wearing restrictive clothing and encourage regular hydration. It also advises against consuming gas-producing foods or drinks before a flight.

Other ways for pregnant women to be comfortable on their flights include: booking a bulkhead seat for more legroom; reserving an aisle seat for easy access to lavatories and to walk; elevating your legs on a carry-on bag to avoid swelling and cramps; and wearing a layered, comfortable outfit for changing cabin temperatures.

Airlines around the world have different rules and regulations on when and how long pregnant women can fly. Below are the policies from 25 airlines around the world.

The French flag carrier does not require pregnant women to carry a medical certificate for travel during pregnancy. It recommends avoiding travel in the final month of pregnancy, as well as during the first seven days after delivery. The airline also recommends expecting mothers seek their doctor's opinion before traveling.

India’s flag carrier allows expectant mothers in good health to fly up to and including their 27th week of pregnancy. After 27 weeks, if the pregnancy is anticipated to be a normal delivery, an expectant mother will be accepted for travel up to the 35th week, but a medical certificate confirming the mother is fit to travel is required by an attending obstetrician and dated within three days of travel.

Air New Zealand

For single, uncomplicated pregnancies and clearance from a doctor or midwife women can take flights more than four hours up to the end of their 36th week. For flights under four hours, it's up to the end of the 40th week. Women pregnant with twins can fly more than four hours up to their 32nd week and less than four hours until the 36th week.

The airline recommends that women past their 28th week carry a letter from a doctor or midwife that says you are fit for travel, confirming your pregnancy dates and that there are no complications.

The airline's medical team must offer clearance for women experiencing the following: a complicated pregnancy, such as placenta previa or bleeding; a multiple pregnancy; a history of premature labor; or have begun the early stages of labor. 

Italy's flag carrier has no travel restrictions for expectant mothers during the first eight months of pregnancy. But if traveling within the last four weeks of pregnancy, expecting multiple births, or having a complicated pregnancy, medical clearance is required. Completion of a Medical Information Form, MEDIF , prior to travel and signed by both the passenger and doctor is required.

Alitalia advises pregnant not to fly seven days prior to and seven days after giving birth, or if there is a risk of a premature birth or other complications. It will make staff available to escort pregnant women from the airport check-in counter to the boarding gate. Staff onboard the flight will help stow carry-on luggage. Seats can be pre-assigned and women cannot sit in an exit row.

All Nippon Airways

The Japanese carrier requires women within 15 to 28 days of their due date to fill out and carry a medical information form . Women within 14 days of their due date are required to have a medical form and travel with a doctor. The form must indicate there are no complications of pregnancy, that the passenger has no health problems preventing them from flying and the due date. It must be completed by a doctor and submitted no more than seven days prior to departure.

American Airlines

The Fort Worth-based carrier has different rules for international and domestic flights. If a due date is within four weeks of a flight, you must provide a doctor’s certificate stating that you’ve been recently examined and you’re fit to fly. For domestic flights under five hours, pregnant women won’t be permitted to travel within seven days (before and after) their delivery date. Those who need travel within this timeframe will need approval from a physician and help from a special assistance coordinator . The pregnant woman's physician will be required to fill out a passenger medical form before a flight. A special assistance coordinator will send the form directly to your physician.

Clearance from a special assistance coordinator is required for international travel or travel over water. Within four weeks of a due date also requires a physician's note stating that you’ve been examined within the past 48 hours and you’re fit to fly. And seven days before or after delivery also requires a passenger medical form to be completed by your physician.

British Airways

The U.K. carrier does not allow pregnant women to fly after the end of the 36th week if you are pregnant with one baby or the end of the 32nd week if you are pregnant with more than one baby. While it isn't mandated, British Airways recommends all expecting mothers carry a confirmation from a doctor or midwife, such as a letter or certificate, in addition to your pregnancy record. It should be written within seven days prior to travel and confirm your approximate due date, that you're fit to travel and that there are no complications with your pregnancy.

Cathay Pacific

 Hong Kong's flag carrier requires that women with pregnancies after 28 weeks carry a medical certificate, dated within 10 days of travel that states the following: 

• single or multiple pregnancy
• estimated week of pregnancy
• expected due date 
• certifying you are in good health and the pregnancy is progressing normally, without complications
• that you are fit to travel

The airline accepts pregnant women with uncomplicated single pregnancies to travel up to 36 weeks and uncomplicated multiple pregnancies up to 32 weeks.

Delta Air Lines

The Atlanta-based carrier does not impose restrictions on flying for pregnant women, so a medical certificate is not required to travel. But the airline will not waive ticket change fees and penalties for pregnancy. The airline recommends that those flying after their eight month should check with their doctor to be sure travel is not restricted.

The U.K.-based airline has no restrictions for pregnant passengers traveling up to the end of the 35th week of single pregnancies and the end of the 32nd week for multiple pregnancies.

Pregnant women can travel up to their 29th week without a medical certificate. After that, they require a certificate or letter signed by a qualified doctor or midwife that states whether the pregnancy is single or multiple, is progressing without complications, includes an estimated due date, that you are in good health and there's no known reason to prevent you from flying. Pregnant passengers are not allowed to fly after the 32nd week of a multiple pregnancy, and after the 36th week of a single pregnancy.

This Abu Dhabi-based carrier allows women with single or multiple pregnancies to travel during the first 28 weeks without a medical certificate. For single pregnancies between 29 and 36 weeks, a medical certificate is required. After 37 weeks, pregnant women will not be allowed to travel. For multiple pregnancies, a certificate is required between the 29th and 32nd week; after that, women will not be allowed to travel.

The medical certificate must include the following: 

• Be issued and signed by a doctor or midwife
• Written on a clinic/hospital letterhead and/or stamped by the doctor or midwife
• State that the guest is fit to fly
• State if the pregnancy is single or multiple
• State the number of weeks of pregnancy and the Expected Date of Delivery 
• Easily understood and written in Arabic or English. Other languages are accepted but must be verified by Etihad Airways' check-in staff

The original medical certificate shall be accepted for the whole journey (originating, return and stopover flights), provided the above validity criteria is met for each sector. And it is valid for three weeks from the date of issue.

The New York-based carrier does not allow pregnant customers expecting to deliver within seven days to travel unless they provide a doctor's certificate dated no more than 72 hours prior to departure stating that the woman is physically fit for air travel to and from the destinations requested on the date of the flight and that the estimated date of delivery is after the date of the last flight.

The Dutch flag carrier recommends pregnant mothers not fly after the 36th week, along with the first week following delivery. For those expecting more than one baby, the carrier recommends consulting with a physician prior to flying. If you have had complications, you always need to have permission to fly from your physician.

Expectant mothers with complication-free pregnancies can fly on the German flag carrier until the end of the 36th week of pregnancy or up to four weeks before their expected due date without a medical certificate from a gynecologist. But the airline recommends that pregnant women beyond the 28th week have a current letter from a gynecologist that includes confirmation that the pregnancy is progressing without complications and the expected due date. The doctor should expressly state that the patient’s pregnancy does not prevent her from flying.

Because of the increased risk of thrombosis during pregnancy, the airline does recommend that expectant mothers wear compression stockings while flying.

Malaysia Airlines

The Malaysian flag carrier requires medical clearance for expectant mothers approaching 35 weeks for international travel or 36 weeks for domestic travel. If medical clearance is required, the MEDIF application form should be completed by a doctor and submitted to the airline through its ticketing offices or travel agents at least five working days before traveling.

Philippine Airlines

An expectant mother who is in normal health and with no pregnancy complications will be allowed to fly after filling out an EMIS form . Pregnant women may be accepted for travel if they are not beyond 35 weeks when they fill out Part One of the EMIS form. Those between 24 and 32 weeks of pregnancy will have to fill out EMIS Form Part 2. And if the expectant mother is below 21 years of age, the consent in writing of the husband, parent or guardian must be secured. For expectant mothers beyond 32 weeks of pregnancy, EMIS Part 3 must be accomplished by the Flight Surgeon or Company Physician, who shall issue the clearance for travel

After the 28th week, women are required to have a certificate or letter from a registered medical practitioner or registered midwife confirming the delivery date, whether it's a single or multiple pregnancy and that the pregnancy is routine.

For flights longer than four hours, women can fly up to the end of the 36th week for single pregnancies and the end of the 32nd week for multiple pregnancies. For flights under four hours, women can travel up to the end of the 40th week for single pregnancies and the end of the 36th week for multiple pregnancies. The carrier requires medical clearance  if there are pregnancy complications or it's not a routine pregnancy.

Qatar Airways

 No doctor's note is required for women traveling through their 28th week of pregnancy. Expectant mothers can fly between week 29 and week 32 with a doctor's note and a pregnancy with no complications. Those with a multiple pregnancy will need a doctor's note and a  Medical Information Form (MEDIF) . Between weeks 33 and 35, women will need a doctor's note and a MEDIF. The airline does not accept women in their 36th week and beyond.

 The low-cost Irish carrier allows expectant mothers to fly up to their 28th week of pregnancy. After that, the airline requires women to have a ‘fit to fly’ letter from their midwife or doctor. For an uncomplicated single pregnancy, travel is not permitted beyond the end of the 36th week of pregnancy, while the cut-off for an uncomplicated multiple pregnancy is 32 weeks. 

Singapore Airlines

For uncomplicated single pregnancies, the carrier restricts expectant mothers from travelling beyond the 36th week of pregnancy; for uncomplicated multiple pregnancies, the restriction is the 32nd week.

For uncomplicated single pregnancies between 29 weeks and 36 weeks, expectant mothers must provide a medical certificate stating the following: (1) fitness to travel, (2) number of weeks of pregnancy and (3) estimated date of delivery. The certificate should be dated within ten days of the date of the first flight exceeding 28 weeks of pregnancy. This certificate will have to be presented at check-in when requested.

Southwest Airlines

The Dallas-based carrier advises expectant mothers at any stage of pregnancy to consult with their physicians prior to air travel. The airline recommends against air travel beginning at the 38th week of pregnancy. It warns that in some cases, traveling by air has been known to cause complications or premature labor. Depending on their physical condition, strength, and agility, pregnant women may, in some cases, be asked not to sit in the emergency exit row.

Turkish Airlines

Turkey's flag carrier allows mothers pregnant with one child to travel between the 28th and 35th week if they have a doctor's report that includes the phrase, “There is no particular reason for the patient not to fly.” For women pregnant with more then one baby, the travel cut-off is the end of the 31st week with a doctor's report. The report has to be no more than seven days from the travel date. 

United Airlines

Any woman in the first 36 weeks of pregnancy will be allowed to travel on the Chicago-based carrier without medical documentation. An expectant mother traveling after the 36 weeks of pregnancy must have the original and two copies of an obstetrician’s certificate, which must be dated within 72 hours of a flight’s departure. The original certificate should be submitted to a United representative at check-in.

Virgin Atlantic

 The London-based airline allows travel without restrictions until the 28th week of pregnancy provided that you're free from complications to that point. The carrier asks pregnant mothers to inform its Special Assistance department so they can offer appropriate inflight health advice. Between the 28th and 36th weeks of pregnancy, a doctor's or midwife's certificate is required, stating that the passenger is safe for travel and the expected due date (32 weeks if carrying multiples in an uncomplicated pregnancy). Beyond the 36th week of pregnancy, travel is only permitted for medical/compassionate reasons and the pregnant passenger is required to be accompanied by a medical escort. This travel is subject to the approval of a Virgin Atlantic doctor.

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15 Tips for Traveling While Pregnant

These tips will help pregnant women travel the world in comfort and style.

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Experts share their best travel tips for expecting mothers.

Pregnancy can be a magical experience, but that doesn't mean creating new life comes without challenges. From what you wear to how you move your body to how well you sleep, pregnancy changes your day to day in myriad of ways – both good and bad.

However, that doesn't mean you should stay home and avoid travel for the entire nine months you're with child. The American College of Obstetricians and Gynecologists says it's typically safe to travel until you're 36 weeks pregnant, so you may as well get out and see the world.

These tips can help you ensure your pre-baby travel is safe, comfortable and fun.

Travel When You're Most Comfortable

According to the ACOG, the best time for pregnant women to travel is between 14 and 28 weeks, or during the middle of your pregnancy.

The most common pregnancy problems occur in the first and third trimesters, according to the health organization. "During midpregnancy, your energy has returned, morning sickness usually is gone, and it is still easy to get around," according to the ACOG.

If you have the option to be flexible with your travel dates, steering clear of early and late pregnancy trips may save you from having to endure an unenjoyable experience.

[Read: 9 Reasons Getting Away for the Weekend is Good for Your Mental Health .]

Have a Plan B

Robert Quigley, senior vice president at International SOS and MedAire, says you should meet with your doctor and get cleared to travel before you depart on any trip. Also, take the time to research medical facilities near where you'll be staying, he says, since you won't want to have to frantically figure out where to go if you experience complications.

Early planning can include checking nearby hospitals that you contact ahead of your trip, and locating pharmacies and additional prenatal resources in your destination should you go into early labor.

"This may also include a communication plan for friends or family should they need to join you, and an evacuation plan to upgrade your care in the event of a complication," he says.

Purchase Travel Insurance

Travel writer and mom of two Natalie Preddie, who blogs at NattyPOnline.com , says you should buy travel insurance that includes medical coverage before your trip if you're visiting a destination where your health insurance won't apply.

Preddie says when she was pregnant, she had to go to a hospital in Florida during a trip because she thought her baby wasn't moving. She says she was glad her health insurance was accepted right away, but she worries what would have happened if she had to pay for a lengthy hospital stay or tests out of pocket.

Bring Your Medical Records with You

Lee Roosevelt, who works as nurse midwife at the University of Michigan – Ann Arbor, says you can gain peace of mind and expedite any medical care you might need by bringing a copy of your pregnancy-related medical records along on your trip.

"Offices can take a day or two to return a request for records, and if you need care quickly it means your team of providers [is] making decisions without knowing the details of your pregnancy," she says.

Be Proactive About Your Health

Roosevelt also says that when it comes to pregnancy, you should take steps to avoid common health problems regardless of whether you're on a trip or at home. She recommends taking plenty of walking breaks since "pregnant women are at higher risk for blood clots and prolonged sitting increases that risk."

You should try to get up and walk for five to 10 minutes every few hours if you can, even if you're on an airplane.

Roosevelt also noted that buying and wearing compression socks during air travel can help you avoid swelling, blood clots and more.

[Read: 30 Travel Accessories That Make Vacationing Easier .]

Stay Hydrated

In the same vein of being mindful about your health and wellness, drink lots of water so you stay hydrated. Dehydration can make you feel unwell and put you at risk for pre-term contractions, Roosevelt says.

Plan to bring your own refillable water bottle while you travel so you can stay hydrated no matter where you are, whether that's on the road or in the air.

Pack Healthy Snacks

Airports don't always have many healthy dining options, and what is available tends to be expensive. To save money and avoid having to nosh on empty calories, it can help to bring your own selection of sensible snacks along.

Consider packing healthy snacks like dried fruit and vegetables if you can. The U.S. Department of Health and Human Services also recommends eating whole grain toast or crackers when you’re feeling nauseous or unwell, and healthy crackers should be easy to pack in your bag and bring along.

Bring Sanitizing Wipes and Gel

The ACOG says that, if you're going on a cruise specifically, you'll want to take steps to avoid norovirus – a group of viruses that can spread quickly and cause severe nausea and vomiting.

Washing your hands frequently is the best way to avoid it, but antibacterial hand gel can help you ward off germs as well. Meanwhile, disinfecting wipes are good to have on hand to wipe down airplane tray tables and arm rests.

The Government of Canada also recommends pregnant women vigorously wash their hands before eating or preparing food as well. Following these recommendations is especially important when you're in a busy airport or dining on a germ-infested airplane.

Keep Car Rides Short

If you're planning a road trip or need to drive a long distance to reach your destination, it can be beneficial to break up your travel over several days. That way, you'll only have to sit for shorter spurts of time rather than long stretches that can leave you vulnerable to swelling, blood clots and other pregnancy-related complications.

The ACOG also notes that you should buckle your seatbelt low on your hipbones, below your belly, and "place the shoulder belt off to the side of your belly and across the center of your chest."

Plan to make frequent stops so that you can get out and stretch your legs, and your car ride will be more enjoyable and keep you and the baby safe.

Book an Aisle Seat When You Fly

If you plan to fly while you're pregnant, book an aisle seat ahead of time – even if you need to pay extra for it. Having an aisle seat will make it easier for you to get up and walk around, and to head to the toilet for the many bathroom breaks you'll likely need to take.

If you can, splurge (or use points ) for business class to score some extra room.

Don't Overbook Yourself

Sightseeing is a lot of fun pregnant or not, but don't forget that your energy levels may be lower by the time you're ready to depart.

Make sure to plan an itinerary that includes plenty of breaks and downtime. You may even want to plan a relaxation-themed trip altogether, such as a spa getaway or a trip to an all-inclusive resort .

Be Choosy About Your Destination

Be mindful of seasonal weather trends and how they might work for your pregnant self. If you are planning a beach getaway in the middle of July and considering Naples in southern Florida, for example, it's smart to know ahead of time that daily high temperatures usually reach 89 degrees and humidity levels often fall in the "oppressive" or "miserable" range in the summer. Doing your research could help you find a destination with better weather, such as a beach spot with lower humidity like Virginia Beach, Virginia or Cape Cod, Massachusetts .

When it comes to trip planning, Google is your friend. Make sure you know how the weather might look no matter where you are planning to travel or you could live to regret it.

[See: 30 Relaxing Meditation Retreats Around the World .]

Pack a First-Aid Kit

There's nothing worse than being in transit for hours without supplies for headaches, heartburn and other pregnancy-related ailments. If you're prone to not feeling well at home or when you travel, you may want to bring a small first-aid kit along.

While your kit can include whatever you want, consider packing medicine for heartburn, bloating, gas and nausea – or whatever has been bugging you the most.

Check If You Need Clearance to Fly

While most airlines let you fly without question until you're up to 36 weeks pregnant, some international carriers, including Cathay Pacific and Emirates, need verification of your health from your doctor with a medical certificate before you board the plane.

If you plan to fly domestically or abroad, make sure to check with the air carriers you're considering as you organize the trip. Most airlines typically list this information on their websites, but you can also call to ask if you'll need any specific documentation.

Choose the Right Luggage

Finally, don't forget to bring luggage that's easy to move around from place to place. Spinner-style luggage on wheels is typically the easiest to transport, and you should strive to pack light (within reason) so you're not stuck lugging around all the clothing and shoes you own.

Don't hesitate to check your luggage either – especially if you have a layover to endure. The less you have to carry around, the smoother your trip should be.

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Advice for pregnant travellers.

If you're pregnant and planning to travel overseas, research your destination before you go. Consult your doctor and understand potential risks to you and your unborn child. Being informed about the risks will help you manage them. It will increase your chance of having a great time overseas. Explore this page to learn about:

• planning for travel during pregnancy
• medications and pregnancy
• terminating a pregnancy overseas
• going overseas to give birth
• how the Australian Government can help overseas

This page is for Australians who are pregnant, or planning to get pregnant overseas. If you're looking for information about adopting a child or engaging in surrogacy, refer to surrogacy and adoption .

Planning for travel during pregnancy

Travelling when pregnant can be challenging, but there are things you can do to stay safe and comfortable and reduce your risks.

Timing your travel

Visit your doctor or obstetrician at least 8 weeks before you go. Discuss the timing and location of your trip. Check if you're allowed to travel and if they recommend travel.

If they advise against travel, don't go. Find time to travel later, when the risk has passed.

Airlines and cruise lines have specific rules on when you can travel while pregnant. If you're having more than one baby, the rules may differ again. Most airlines won't let you fly beyond 28 weeks of pregnancy.

Ask your airline or cruise line about any rules or restrictions that could affect you while in transit.

Read more about pregnancy and travel (Victorian Government Department of Health and Human Services).

Choosing where to travel when you're pregnant

Consider the risks of going overseas, including the risks to your unborn child.

You and your baby will be more at risk in some countries. Avoid countries with poor sanitation, hygiene and medical facilities. Read the travel advisory for each country you're visiting. Note the health risks.

If the travel advisory says do not travel to that country, then do not travel at this time. You're putting yourself and your unborn child at serious risk.

Things can go wrong quickly when you're pregnant. Check how close you'll be to good medical facilities. Stay within reach of hospitals and doctors.

See a doctor before you go

See a doctor at least once before you travel. Your doctor will advise what vaccines and medications you can take when you're pregnant.

If you have a high-risk pregnancy, your doctor may advise against travel. If they advise against travel, then don't go. You're putting yourself and your unborn child at serious risk.

Most airlines will ask you to show a letter from your doctor.

Buy travel insurance to cover pregnancy

You need travel insurance.

Ask your travel insurer if your policy covers:

• pregnancy, and until what stage
• IVF pregnancy, if applicable
• pregnancy complications or premature birth while you're away
• cancellation of your trip due to pregnancy or birth issues

For cover during pregnancy, you may need to pay extra. You may need medical evidence. You may face limitations to your cover, depending on where you're going. For example, in Saudi Arabia, medical insurance won't cover pregnancy unless you're married.

Read more about travel ins urance .

Medications and pregnancy

Not all medication available over the counter or by prescription in Australia is available in other countries. Some may even be considered illegal or a controlled substance, even if prescribed by an Australian doctor.

Get the facts, before you go.

• See if your medication is legal in your destination .
• Ensure you have enough medication for your trip.
• Check with a doctor that your medication is suitable for travel.

Refer to the 'Look after your health' section on Advice for women travellers for more information. Also see our advice on travelling with medications .

Terminating pregnancy overseas (abortion)

Abortion and the law.

Abortion may be illegal in the country you're visiting.

You're subject to all local laws and penalties, including those that may appear harsh by Australian standards. Research local laws before considering an abortion.

If you're arrested or jailed for having an abortion, the Australian Government will do what it can to help you. However, we can't get you out of trouble or out of jail.

• Understand our limits. Read the Consular Services Charter .

Health care standards overseas can vary. If you choose to end your pregnancy, find a proper medical facility to help you.

Choose the safest option, not the cheapest option.

Read more about medical assistance overseas .

Medical treatment for ending a pregnancy can be costly. As with other medical procedures overseas, get a quote from the hospital first.

Find out if this procedure is covered by your travel insurance . If not, consider the cost of having this procedure overseas versus back in Australia. You may be eligible for subsidised care in Australia through Medicare.

Read more about travel insurance .

Going overseas to give birth

If you choose to give birth overseas, you'll need to check:

• healthcare costs and travel insurance
• safety and quality of care
• your budget to pay for a private hospital, if you aren't covered by the public health system via a partner or a reciprocal agreement
• any changes to your legal status, marriage and parent rights
• if you need a special visa as a medical tourist

Citizenship and passports

Giving birth overseas doesn't automatically grant your child citizenship of that country. Research local immigration and citizenship laws before you travel.

If authorities think you're planning to give birth there for visa reasons, they may refuse you entry.

In Australia

To register your child's birth with Australian authorities, you'll need to contact your state or territory registry of births, deaths and marriages (Australian Government).

Consular officials can assist with your child's passport .

There may be higher costs for processing a passport for your baby while you're overseas.

• Learn more about Australian citizenship by descent (Department of Home Affairs).

Becoming a new parent can feel overwhelming. Consider how you'll find support overseas, both practically and emotionally.

Supplies and services

Prepare ahead for how you'll travel with your new baby. Make sure you have all the medications and supplies you need.

The Australian Government can't help with medical costs or services overseas.

Learn more about medical assistance overseas .

If our travel advisory for the country in which you plan to give birth says ' do not travel ', then don't travel there. You're putting yourself and your unborn child at serious risk.

Learn more about staying safe and avoiding danger .

Consular services and pregnancy

The Australian Government is limited in how and when it can help Australians overseas.

In most cases, when you need help overseas you, or your travel insurer, must organise and pay for it.

What we can do

• We can give you a list of local medical facilities with doctors who speak English.
• We can give you a list of local lawyers who speak English.
• We can help you contact your family in Australia in an emergency.
• We can notify you when we update our travel advice for your destination . Learn more about subscriptions .

What we can't do

• We can't guarantee your safety when you travel.
• We can't pay for your bills if you need medical assistance overseas .
• We can't get you out of jail if you're arrested because you've broken a local law. Be aware laws vary greatly on abortions, medications and sex outside of marriage.
• We can't give you medical or legal advice.

Final tips before you go

Prepare before you travel:

• get medical advice, vaccinations and a health check
• know the laws about pregnancy, adoption, surrogacy and abortion overseas
• arrange adequate travel insurance and check coverage
• arrange emotional and practical support
• Read our general advice for people travelling with children .
• See information about international surrogacy .
• See information about going overseas to adopt .
• Before you go, get travel insurance that covers your pregnancy.
• See more advice on pregnancy and travel (Victorian Department of Health and Human Services).
• Read more about travelling while pregnant (CHOICE).

Related content

Information for Australians going overseas for surrogacy. Learn about types of arrangements, laws, citizenship and visas.

Many Australians adopt children from other countries. There are legal implications surrounding overseas adoptions both in Australia and in the child's country.

All travellers face risks overseas. In certain countries or cultures, women face greater risks than men and may be more vulnerable.

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Travelling while pregnant

Find useful information and considerations to help you prepare for safe and healthy travels outside Canada while pregnant.

With careful preparation, travelling while pregnant can be safe. The decision to travel should be made in consultation with your health care professional, based on your personal health circumstances.

On this page

Before you go, while you're away, if you need help.

Medical practices, health standards and infection control measures vary from country to country. You may not have access to the same level of care, procedures, treatments and medications as you would in Canada.

You could also be at increased risk of getting an infection and/or developing severe complications from certain infections, which could also affect the fetus.

Before leaving Canada:

• consult a health care professional or visit a travel health clinic at least 6 weeks before travelling to get personalized health advice and recommendations
• check our Travel Advice and Advisories for country-specific information, including about possible health risks
• know how to seek medical assistance outside of Canada
• review the policy and the coverage it provides
• most policies do not automatically cover pregnancy-related conditions or hospital care for premature infants
• ask your insurance provider about coverage for medical care during pregnancy, giving birth and intensive care for you and your fetus or newborn
• carry a copy of your prenatal records
• talk to your health care professional about any additional items you may want to bring that are specific to your health needs

Local laws and medical services relating to pregnancy can differ from Canada. Learn the local laws, and how these may apply to you before you travel.

Pre-travel vaccines and medications

Many vaccines can be safely given during pregnancy. Due to a higher risk of more severe outcomes for you and your fetus, some vaccines are recommended specifically during pregnancy, such as tetanus-diphtheria-pertussis (DTaP) and influenza.

Don’t take medications you may still have from prior trips. Tell the health care professional about your pregnancy, or intended pregnancy, before filling any prescriptions. The decision to get any pre-travel vaccinations or medications should be discussed with your health care professional.

The decision can depend on:

• your purpose of travel (e.g., tourism, visiting friends and relatives)
• your planned destination(s)
• the length of your trip
• your risk of getting a disease
• how severe the effect of a disease would be to you and/or your fetus
• your planned activities
• any underlying medical issues and/or pregnancy-related complications

Malaria could cause major health problems for a mother and her unborn baby. A pregnant woman may want to consider avoiding travel to areas where malaria transmission occurs.

Description of malaria risk by country and preventative measures.

If you can’t avoid travelling to an area where malaria is present:

• some medications to prevent or treat malaria may not be safe during pregnancy
• take extra care to protect yourself from mosquito bites

Zika virus infection during pregnancy can pose significant risks to your fetus even if you don’t develop symptoms. While pregnant, you may want to consider avoiding travelling to a country or areas with risk of Zika virus.

Latest travel health advice on Zika virus.

If you choose to travel, take precautions to avoid infection with Zika virus:

• prevent mosquito bites at all times
• protect yourself from contact with semen, vaginal fluid and blood
• always use condoms correctly or avoid sexual contact while in countries or areas with risk of Zika virus

Learn more about Zika virus and pregnancy:

• Zika virus: Pregnant or planning a pregnancy
• Zika virus: Advice for travellers
• Pregnancy and travel (tropical medicine and travel)

Monitor your health and be prepared

Emergencies can happen at any time. Know where the nearest hospital or medical centre is while you are travelling and confirm they will accept your medical insurance.

Seek medical attention immediately if you develop any of the following symptoms while travelling:

• persistent vomiting and/or diarrhea
• dehydration
• vaginal bleeding
• passing tissue or clots
• abdominal pain, cramps or contractions
• your water breaks
• excessive swelling of face, hands or legs
• excessive leg pain
• severe headaches
• visual problems

If you develop these symptoms after your return to Canada, you should see a health care professional immediately and tell them about your recent trip.

Transportation

Always wear a seatbelt when travelling by plane or car. When using a diagonal shoulder strap with a lap belt, the straps should be placed carefully above and below your abdomen. If only a lap belt is available, fasten it at the pelvic area, below your abdomen.

If you have any medical or pregnancy-related complications, discuss with your health care professional whether air travel is safe for you.

Most airlines restrict travel in late pregnancy or may require a written confirmation from a physician. Check this with the airline before booking your flight.

During long flights, you may be at higher risk of developing blood clots, known as deep vein thrombosis (DVT). The risk of deep vein thrombosis can be reduced by:

• getting up and walking around occasionally
• exercising and stretching your legs while seated
• selecting an aisle seat when possible
• wearing comfortable shoes and loose clothing

Your health care professional may recommend additional ways to reduce your risk such as wearing compression stockings.

Always stay well hydrated while travelling.

Land travel

The risk of deep vein thrombosis can be reduced by:

• stopping the vehicle to walk around every couple of hours

Motion sickness

Certain medications used to treat nausea and vomiting during pregnancy may also be effective in relieving motion sickness.

If you think you might experience motion sickness during your trip, speak to your health care professional about the use of these medications.

Environmental and recreational risks

Some activities may not be recommended or may require additional precautions. Discuss your travel plans, including any planned or potential recreational activities with a health care professional.

High altitude

You should avoid travelling to an altitude above 3,658 metres (12,000 feet).

However, if you have a high-risk pregnancy and/or are in the late stages of pregnancy, the highest altitude should be 2,500 metres (8,200 feet).

If you have pregnancy-related complications, you should avoid unnecessary high-altitude exposure.

Keep in mind that most high-altitude destinations are far from medical care services.

Personal protective measures

Food-borne and water-borne diseases.

Eat and drink safely while travelling while travelling. Many food-borne and water-borne illnesses can be more severe during pregnancy and pose a risk to the fetus.

This can include:

• toxoplasmosis
• listeriosis
• hepatitis A and E

To help avoid food-borne and water-borne diseases:

• before eating or preparing food
• after using the bathroom or changing diapers
• after contact with animals or sick people
• before and after touching raw meat, poultry, fish and seafood
• if you’re at a destination that lacks proper sanitation and/or access to clean drinking water, only drink water if it has been boiled or disinfected or if it’s in a commercially sealed bottle
• use ice made only from purified or disinfected water
• this could cause the fetus or newborn to develop thyroid problems
• unpasteurized dairy products, such as raw milk and raw milk soft cheeses
• unpasteurized juice and cider
• raw or undercooked eggs, meat or fish, including shellfish
• raw sprouts
• non-dried deli meats, including bologna, roast beef and turkey breast
• don’t use bismuth subsalicylate (Pepto-Bismol®)
• Information on travellers’ diarrhea

Illnesses acquired from insect and other animals

Protect yourself from insect bites:

• wear light-coloured, loose clothes made of tightly woven materials such as nylon or polyester
• prevent mosquitoes from entering your living area with screening and/or closed, well-sealed doors and windows
• use insecticide-treated bed nets if mosquitoes can’t be prevented from entering your living area
• information on insect bite and pest prevention

Some infections, such as rabies and influenza, can be shared between humans and animals. You should avoid contact with animals including dogs, livestock (pigs, cows), monkeys, snakes, rodents, birds, and bats.

Information for if you become sick or injured while travelling outside Canada.

For help with emergencies outside Canada, contact the:

• nearest Canadian office abroad
• Emergency Watch and Response Centre in Ottawa

More information on services available at consular offices outside Canada.

Related links

• Immunization in pregnancy and breastfeeding: Canadian Immunization Guide
• Advice for Canadians travelling to Zika-affected countries
• Advice for women travellers
• If you get sick before or after returning to Canada
• Receiving medical care in other countries
• Travel vaccinations
• What you can bring on a plane
• Tips for healthy travel

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Increased Oropouche Virus Activity and Associated Risk to Travelers

Distributed via the CDC Health Alert Network August 16, 2024, 4:00 PM ET CDCHAN-00515

Summary The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians and public health authorities of an increase in Oropouche virus disease in the Americas region, originating from endemic areas in the Amazon basin and new areas in South America and the Caribbean. Between January 1 and August 1, 2024, more than 8,000 cases of Oropouche virus disease were reported, including two deaths and five cases of vertical transmission associated with fetal death or congenital abnormalities. Countries reporting cases include Brazil, Bolivia, Peru, Colombia, and Cuba. In the United States and Europe in 2024, travel-associated cases have been identified in travelers returning from Cuba and Brazil. As testing and surveillance for Oropouche virus disease increase in the Americas, reports of cases from additional countries are expected. This Health Advisory advises on evaluating and testing travelers who have been in impacted areas with signs and symptoms consistent with Oropouche virus infection. It also raises awareness of the possible risk of vertical transmission (e.g., from gestational parent to fetus during pregnancy) and associated adverse effects on pregnancy and highlights prevention measures to mitigate additional spread of the virus and potential importation into unaffected areas, including the United States.

Background Oropouche virus belongs to the Simbu serogroup of the genus Orthobunyavirus in the Peribunyaviridae family. The virus was first detected in 1955 in Trinidad and Tobago and is endemic in the Amazon basin. Previous outbreaks have been described in Bolivia, Brazil, Colombia, Ecuador, French Guiana, Panama, and Peru. One child was infected in Haiti in 2014. The current 2024 outbreak is occurring in endemic areas and new areas outside the Amazon basin; countries reporting locally acquired (autochthonous) cases include Brazil, Bolivia, Peru, Colombia, and Cuba. Although travel-associated cases have been identified in the United States (n=11), no evidence of local transmission currently exists within the United States or its territories.

Sylvatic (enzootic) transmission of Oropouche virus occurs in forested areas between mosquitoes and non-human vertebrate hosts (e.g., sloths, non-human primates, domestic and wild birds, and rodents). Humans can become infected while visiting forested areas and are likely responsible for introducing the virus into urban environments. Humans contribute to the transmission cycle in urban environments since infected humans develop sufficient viremia to serve as amplifying hosts. Biting midges ( Culicoides paraensis ) and possibly certain mosquitoes ( Culex quinquefasciatus) are responsible for transmitting the virus from an infected person to an uninfected person in urban areas.

Approximately 60% of people infected with Oropouche virus become symptomatic . The incubation period is typically 3–10 days. Initial clinical presentation is similar to diseases caused by dengue , Zika , and chikungunya viruses, with acute onset of fever, chills, headache, myalgia, and arthralgia. Other symptoms can include retroorbital (eye) pain, photophobia (light sensitivity), nausea, vomiting, diarrhea, fatigue, maculopapular rash,conjunctival injection, and abdominal pain. Clinical laboratory findings can include lymphopenia and leukopenia, elevated C-reactive protein (CRP), and slightly elevated liver enzymes. Initial symptoms typically resolve after a few days, but a high proportion (about 70%) experience recurrent symptoms days to weeks after resolution of their initial illness. Although illness is typically mild, it is estimated less than 5% of patients can develop hemorrhagic manifestations (e.g., epistaxis, gingival bleeding, melena, menorrhagia, petechiae) or neuroinvasive disease (e.g., meningitis, meningoencephalitis). Neuroinvasive disease symptoms may include intense occipital pain, dizziness, confusion, lethargy, photophobia, nausea, vomiting, nuchal rigidity, and nystagmus. Clinical laboratory findings for patients with neuroinvasive disease include pleocytosis and elevated protein in cerebrospinal fluid (CSF).

Although people exposed to biting midges or mosquitoes infected with the virus are most at risk for developing disease, the risk factors for more severe Oropouche virus disease are not well-defined. People at risk for more severe disease likely include those at risk for severe disease with other viral infections transmitted by vectors (e.g., people aged 65 years or older, or those with underlying medical conditions, such as immune suppression, hypertension, diabetes, or cardiovascular disease). Earlier this year, Brazil reported two deaths in otherwise healthy non-pregnant women, and five cases in pregnant people with evidence of vertical transmission of the virus to the fetus associated with fetal death or congenital abnormalities, including microcephaly. This was the first report of deaths and Oropouche virus vertical transmission and associated adverse birth outcomes.

Laboratory diagnosis is generally accomplished by testing serum. Cerebrospinal fluid can also be tested in patients with signs and symptoms of neuroinvasive disease. Diagnostic testing is available at some public health laboratories (e.g., Wadsworth Center, NYS Department of Health) and at CDC. CDC and other public health laboratories are currently working to validate additional diagnostic assays. Contact your state, tribal, local, or territorial health department for more information and to facilitate testing. For current testing and case reporting guidance, visit CDC’s website . In many countries, outbreaks of dengue are occurring in areas with reported Oropouche virus transmission. For patients with suspected Oropouche virus disease, it is important to rule out dengue virus infection because proper clinical management of dengue can improve health outcomes. Other diagnostic considerations include chikungunya, Zika, leptospirosis, malaria, or infections caused by various other bacterial or viral pathogens (e.g., rickettsia, group A streptococcus, rubella, measles, parvovirus, enteroviruses, adenovirus, Mayaro virus).

No specific antiviral treatments or vaccines are available for Oropouche virus disease. Treatment for symptoms can include rest, fluids, and use of analgesics and antipyretics. Acetaminophen is the preferred first-line treatment for fever and pain. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) should not be used to reduce the risk of hemorrhage. Patients who develop more severe symptoms should be hospitalized for close observation and supportive treatment. Pregnant people with laboratory evidence of Oropouche virus infection should be monitored during pregnancy and live-born infants should be carefully evaluated.

Travelers to areas with Oropouche virus transmission should use prevention measures to avoid biting midge and mosquito exposure during travel and for 3 weeks after travel, or if infected during the first week of illness, to mitigate additional spread of the virus and potential importation into unaffected areas in the United States. Oropouche virus disease is not a nationally notifiable condition. However, CDC encourages jurisdictions to report voluntarily to ArboNET , the national arboviral disease surveillance system.

Recommendations for Healthcare Providers

• Abrupt onset of reported fever, headache, and one or more of the following: myalgia, arthralgia, photophobia, retroorbital/eye pain, or signs and symptoms of neuroinvasive disease (e.g., stiff neck, altered mental status, seizures, limb weakness, or cerebrospinal fluid pleocytosis); AND
• No respiratory symptoms (e.g., cough, rhinorrhea, shortness of breath); AND
• Tested negative for other possible diseases, in particular dengue. If strong suspicion of Oropouche virus disease exists based on the patient’s clinical features and history of travel to an area with virus circulation, do not wait for negative testing for other infections before contacting your state, tribal, local, or territorial health department.
• Contact your state, tribal, local, or territorial health department to facilitate diagnostic testing.
• Rule out dengue virus infection in travelers with suspect Oropouche virus infection because these viruses often cocirculate and cause similar clinical presentations during acute illness. Early clinical management of dengue can improve health outcomes.
• Be aware that a high proportion of patients (about 70%) with Oropouche virus disease may experience recurrent symptoms days to weeks after resolution of their initial illness.
• Be aware of the risk of vertical transmission and possible adverse impacts on the fetus, including fetal death or congenital abnormalities. Monitor pregnancies in people with laboratory evidence of Oropouche virus infection and provide thorough infant evaluations.
• Inform pregnant people of the possible risks to the fetus when considering travel to areas with reported Oropouche virus transmission. Counsel these patients to consider the destination, reason for traveling, and their ability to prevent insect bites.
• Pregnant people are currently recommended to reconsider non-essential travel to areas with an Oropouche virus Level 2 Travel Health Notice . If a pregnant person decides to travel, counsel them to strictly prevent insect bites during travel.
• Manage travelers with suspect Oropouche virus disease with acetaminophen as the preferred first-line treatment for fever and pain. Aspirin and other NSAIDS should not be used to reduce the risk of hemorrhage.
• Be aware that people who may be at higher risk for complications or severe disease include pregnant people, older adults (e.g., aged 65 years or older), and people with underlying medical conditions (e.g., immune suppression, hypertension, diabetes, or cardiovascular disease).
• Direct all travelers going to areas with Oropouche virus transmission to use measures to prevent insect bites during travel and for 3 weeks after travel, or if infected, during the first week of illness to mitigate additional spread of the virus and potential importation into unaffected areas in the United States.
• Report all suspected Oropouche virus disease infections to your state, tribal, local, or territorial health department to facilitate diagnosis and mitigate risk of local transmission. For after-hours contact information for health departments please visit: https://www.cste.org/page/EpiOnCall . Please follow standard procedures for reporting during normal business hours.

Recommendations for Health Departments

• Share Oropouche virus prevention messages for travelers and pregnant persons with healthcare providers, travel health clinics and the public.
• Perform surveillance for Oropouche virus disease cases in travelers who have been in areas with Oropouche virus transmission and be aware of risk of possible local transmission in areas where biting midges ( Culicoides paraensis) and mosquitoes ( Culex quinquefasciatus) are currently active.
• Keep current on CDC’s evolving testing and case reporting guidance .
• Assist healthcare providers with obtaining appropriate testing for diagnosing Oropouche virus infection.
• Voluntarily report confirmed and probable Oropouche virus infections to CDC via ArboNET , the national surveillance system for arthropod-borne viruses.
• Contact CDC ( [email protected] ) if concern exists for local transmission in a non-endemic area. Consider if the patient had contact with a person with confirmed Oropouche virus infection, lives in an area where travel-related cases have been identified, or has known vector exposure (e.g., mosquitoes or biting midges).

Recommendations for Travelers

• All travelers can protect themselves from Oropouche, dengue, Zika, and other viruses transmitted by insects by preventing insect bites , including using an Environmental Protection Agency (EPA)-registered insect repellent ; wearing long-sleeved shirts and pants; and staying in places with air conditioning or that use window and door screens.
• Pregnant travelers should discuss travel plans, reasons for travel, steps to prevent insect bites, and potential risk with their healthcare provider.
• Pregnant people considering travel to countries with an Oropouche virus Level 2 Travel Health Notice should reconsider non-essential travel. If travel is unavoidable, pregnant travelers should strictly follow Oropouche virus prevention recommendations to prevent insect bites during travel.
• Travelers should be aware that the most common symptoms of Oropouche virus are fever and headache and that symptoms usually begin 3-10 days after being bitten by an infected midge or mosquito. Most people infected with Oropouche virus feel better within a week, but symptoms often come back.
• Travelers who have been in areas with Oropouche virus transmission should prevent insect bites for 3 weeks after travel.
• Seek medical care and tell their healthcare provider when and where they traveled.
• Not take aspirin or other NSAIDS (e.g., ibuprofen) to reduce the risk of bleeding.
• Continue to prevent insect bites during the first week of illness to avoid further spread, especially in areas where mosquitoes or biting midges are active.

For More Information

• About Oropouche | CDC
• Travel Health Notices| CDC
• Preventing Mosquito Bites | CDC
• Find the Repellent that is Right for You | EPA
• Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control | WHO
• The Lancet Infectious Diseases. Oropouche fever, the mysterious threat. Lancet Infect Dis. 2024 Aug 8:S1473-3099(24)00516-4. doi: 10.1016/S1473-3099(24)00516-4. Epub ahead of print.
• Pan American Health Organization / World Health Organization. Epidemiological Alert: Oropouche in the Region of the Americas: vertical transmission event under investigation in Brazil, 17 July 2024 . Washington, D.C.; 2024.
• Pan American Health Organization / World Health Organization. Epidemiological Alert: Oropouche in the Region of the Americas, 1 August 2024 . Washington, D.C.; 2024.
• Florida Department of Health. Florida arbovirus surveillance Week 31: August 4-August 10, 2024. https://www.floridahealth.gov/diseases-and-conditions/mosquito-borne-diseases/surveillance.html .
• European Centre for Disease Prevention and Control. Oropouche virus disease cases imported into the European Union – 9 August 2024 . Stockholm; 2024.
• Ladner JT, Savji N, Lofts L, et al. Genomic and phylogenetic characterization of viruses included in the Manzanilla and Oropouche species complexes of the genus Orthobunyavirus, family Bunyaviridae . J Gen Virol . 2014 May; 95(Pt 5):1055-1066. doi: 10.1099/vir.0.061309-0.
• Pinheiro FP, Travassos da Rosa AP, Travassos da Rosa JF, et al. Oropouche virus. I. A review of clinical, epidemiological, and ecological findings . Am J Trop Med Hyg. 1981; 30(1):149-60.
• Pinheiro FP, Travassos da Rosa AP, Gomes ML, et al. Transmission of Oropouche virus from man to hamster by the midge Culicoides paraensis . Science . 1982; 215(4537):1251-3. doi: 10.1126/science.6800036.
• Roberts DR, Hoch AL, Dixon KE, et al. Oropouche virus. III. Entomological observations from three epidemics in Pará, Brazil, 1975. Am J Trop Med Hyg . 1981; 30(1):165-71.
• Cardoso BF, Serra OP, Heinen LB, et al. Detection of Oropouche virus segment S in patients and in Culex quinquefasciatus in the state of Mato Grosso, Brazil. Mem Inst Oswaldo Cruz . 2015; 110(6):745-54. doi: 10.1590/0074-02760150123.
• Pan American Health Organization / World Health Organization. Public Health Risk Assessment related to Oropouche Virus (OROV) in the Region of the Americas, 3 August 2024. Washington, D.C.; 2024.

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