AIR TRAVEL DURING PREGNANCY

Prof. Teksen Çamlıbel, M.D.

Obstetrician and Gynaecologist 

 “Is air travel safe for me?” It is the question of an expectant mother’s mind while she is preparing for a holiday. Medical experts confirm that air travel is safe up until week 36 of pregnancy provided it is approved by an obstetrician. However, medical experts forbid air travel in case of a high-risk pregnancy. Obstetrician and Gynaecologist Mustafa Kır, M.D. from Jinemed Medical Centre, has answered the questions you may have in mind regarding air travel during pregnancy.

 What are the changes to human physiology and in an aircraft during air travel?

As you move higher than sea level, both atmospheric pressure and oxygen level drop. After a certain altitude, this would jeopardize human life along with the low ambient temperature. For this reason, during commercial flights, cabin pressure and oxygen level are adjusted regardless of the conditions outside the aircraft.

On-board cabin pressure is usually kept around a height of 6000–8000 feet. Even under these conditions, on-board humidity is low with around 10-20 per cent. Dry air increases insensible water loss. Healthy people adapt to such conditions through various physiological changes in their bodies.

What are the dangers, especially during long-haul flights? How could pregnancy affect these risks?

Immobility, water retention in the legs, pressure on the popliteal veins and hyperviscosity from water loss caused by dry air all increase the risk of a clog in the veins. Should this clog break loose and reach the lungs, a clinical case which we call ‘pulmonary embolism’ occurs. It is also known as ‘Economy Class Syndrome’ as the economy class seats are less wide. Seniors and passengers with additional medical conditions are at a higher risk. With higher levels of coagulation factors, pregnancy also poses a higher risk.

 Would air travel increase the risk of fetal anomalies or a miscarriage?

The results of limited studies on the issue show no data on the role of air travel increasing congenital anomalies. A study by Finnair among their expectant flight attendants attending flights during their first trimester has shown a 30-per cent increase in miscarriages. Today most international airways do not let their pregnant flight attendants and pilots attend any flights.

A study in Saudi Arabia this year showed that frequently flying women on their first pregnancy have a higher chance of premature birth. These results must nevertheless be validated by new studies.

A common recommendation in the light of the current data is: ‘Pregnant women are free to travel by air up until gestational week 36 (8th month) unless there exists a medical condition’.

In which cases, air travel is not recommended during pregnancy?

As a matter of fact, if we are to describe generally, pregnant women should not travel by air in cases with a possible emergency or a high-risk where an immediate medical response is vital. 

Examples would be:

• Threatened miscarriage (usually accompanied with bleeding)
• Findings or doubts about a threatened preterm labour
• High blood pressure
• Diabetes
• Placental disorders
• Severe anaemia
• Fetal growth restrictions

About which factors pregnant passengers should be careful? And what should they ask for from airlines?

• In the first place, they should know the flight policies for a pregnancy of that particular airline. Airlines permit air travel up until week 28 to 36.
• After a certain gestational week (usually week 28) a medical letter or a certificate may be required confirming that there exist no restrictions for air travel from the doctor (or midwife).
• You should make sure you have the name of a medical institution in the area of arrival for possible emergencies and that your health insurance -if any- is applicable.
• You should dress casually and if possible wear compression stockings to increase blood circulation.
• You should make sure that your fluid intake is sufficient.
• You should ask for an aisle seat.
• You should get up and walk as much as possible.
• While seated, you should do exercises for activating lower leg muscles (You can find such exercises on airlines’ magazines).
• It is not always possible to foresee turbulence. Therefore, pregnant women are also advised to keep their seatbelts fastened while seated -just as any passenger.