Pregnant women often ask their obstetricians about the safety of air travel during pregnancy. This stems from the physiological (pregnancy) and environmental (cabin/altitude) changes associated with commercial flights and the risk of preterm labour or obstetric emergency while on board.
The main concern restricting the airlines from accepting pregnant women as passengers relates to the risk of labour, which may disrupt or divert the flight and the lack of appropriate care providers and facilities to manage labour or any obstetric complication in flight.
Therefore there is no significant risk associated directly with flying and indeed air travel may be of great value in obstetric emergencies.
However, pregnant women should avoid air travel from 37 weeks of gestation in an uncomplicated singleton pregnancy and from 32 weeks of gestation in an uncomplicated multiple pregnancy.
Many airlines will require a letter from a midwife or doctor confirming that there are no anticipated complications for flights taken after the 28th week of pregnancy and confirmation of the expected date of delivery.
Women in the first trimester of pregnancy who are at risk of miscarriage or ectopic pregnancy should confirm the location and/or viability of the pregnancy by ultrasound prior to travel.
Most frequent issues include problems within the ear, particularly if there is nasal congestion; which frequently occurs during pregnancy because of vasodilation. This comes as a result of increasing altitude and reduction in barometric pressure.
Motion sickness and pregnancy-induced nausea and vomiting may be accentuated especially in early pregnancy (8 to 16 weeks gestation).
One of the most important risks is that of blood clots in the legs or lungs.
The duration of the flight will lead to significant immobility and increased risk of leg swelling and venous stasis.
In addition, changes in the pregnant circulation and coagulation system may accentuate the risk of thrombosis, particularly if further risk factors are present, such as previous DVT or obesity.
Flights of more than 4 hour duration are associated with a small increase in the relative risk of venous thrombosis, but overall the absolute risk is very small.
The increased cosmic radiation exposure associated with flying is not considered significant in terms of risk to the mother or fetus for occasional flights.
The total radiation dose from an airport security check, which may involve two or three scans, is less than that received from 2 minutes flying at cruising altitude, or from one hour at ground level. With regard to pregnancy, only negligible radiation doses are absorbed into the body and therefore the fetal dose is much lower than the dose to a pregnant woman.
Women should inform their obstetrician or midwife for any health issues; such as low blood levels (anaemia), sickle cell disease, recent bleeding, heart/lung disease or recent bowel surgery/fractures.
In conclusion, for women with an uncomplicated pregnancy and no medical or obstetric risk factors for complications that would contraindicate air travel, there is no indication to give advice against commercial air travel.
Thank you for reading!
Tips for you:
•Reserve an aisle seat, prefer 4-5 rows away from the WC
•Wear graduated compression stockings
•Do in-seat exercises & walk around as much as possible
•Keep well hydrated
•Wear loose, comfy clothing
•Wear your seat belt under the bump (or ask for a seat extender if needed)
RCOG Patient Information Leaflet advice:
References:
RCOG Scientific Impact Paper Air Travel and Pregnancy
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 Sur 2010;65:396–402.
Department for Transport. Protection of air crew from cosmic radiation: Guidance material 2003. [http://webarchive.nationalarchives.gov.uk/+/http://www.dft.gov.uk/pgr/aviation/hci/ protectionofaircrewfromcosmi2961].
Royal College of Obstetricians and Gynaecologists. Reducing the Risk of Thrombosis and Embolism during Pregnancy and the Puerperium (Green-top 37a). London;RCOG:2009.
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