Knocked up abroad: pregnant travel in the first trimester

by Meg Nesterov on

For more on pregnant travel, see parts 1 and 2 of Knocked up abroad: pregnancy in a foreign country here and here.

There’s no question that having a baby changes you: your body, your lifestyle, even your shoe size. One thing I hoped not to change altogether was traveling, as long as it was reasonably safe and comfortable for me and the baby. From the beginning of my pregnancy in Istanbul, my doctor has okayed travel, as long as I get up to stretch frequently on flights and try not to overdo it. Most doctors (and mothers) agree that the second trimester is the most comfortable time for pregnant travel but the first trimester can be a good time as well (while you can still squeeze into pre-maternity clothes and walk without waddling) with a little extra precaution and a little more babying (of the mother, of course).


The first trimester of pregnancy is a tricky time for many women: the risk of miscarriage is highest up to 10 weeks, morning sickness is common, and hormones are running wild. It’s too early to tell anyone outside family or close friends and without a visible belly, it’s impossible for strangers to tell as well. At later points in your pregnancy, a baby bump acts as the international symbol for pregnancy and can make it much easier to express your condition when traveling abroad. If you travel in the early months before showing, you may want to learn the local language words for “I’m pregnant” to avoid a Bridget Jones-esque “mit kinder” scene if you need extra help while traveling.


Over this past December, my husband and I were looking for a good trip to take over the holidays, when I was around 10 weeks pregnant. Our location in Istanbul changes the list of short-haul destinations considerably from what we would have considered from New York, and we debated between a warm-weather beach destination (husband) or a snowy and “Christmassy” European city (me). We ruled out Egypt (not warm enough and not Christmassy), New Zealand (even less convenient to get to than from New York), and Sri Lanka (not enough time to plan properly and some risks of disease I couldn’t be vaccinated against). In the end, we chose…Russia.
Going to Russia in winter while pregnant may seem crazy to some, but for me it made sense: Moscow and St. Petersburg are a few hours from Istanbul by direct flight, my husband speaks fluent Russian in case of any problems, and there was no risk of malaria or eating any food that had spoiled in the sun. While it was cold and snowing during our trip and I couldn’t take advantage of some of Russia’s cold-weather remedies like vodka and saunas, a week in Moscow and St. Petersburg was a perfect mix of exotic and comfortable.

Nearly every cafe had a variety of non-alcoholic and caffeine-free beverages for me to choose from, I even had non-alcoholic sangria, mojitos, and mulled wine in addition to fresh juices and herbal teas. Both cities are beautiful to explore in the snow, with plenty of museums and cafes to warm up in, and the New Year holiday displays made it festive.

If you are planning a trip to a foreign country while pregnant, it makes sense to keep in mind the following guidelines. Always discuss plans with your doctor before booking and err on the side of caution when choosing a destination.

Check airline restrictions – Most airlines allow pregnant women to fly internationally up to 28 weeks, after which you must provide a doctor’s note issued within a week or so of departure. 35 weeks (earlier for women carrying multiples) is the cutoff for nearly all airlines to prevent women from giving birth on board. Most US domestic carriers will allow pregnant women to fly up to the final month; hilariously, Continental will not let women board if “physical signs of labor are present” though they don’t specify what.

Consider travel insurance – If your medical insurance doesn’t cover you overseas, you may want to look into supplementary medical travel insurance, but be sure it covers pregnancy as many policies do not. Additionally, if you are traveling to a country where English is not spoken, you may want to research the name of a clinic or doctor in case of emergency as well.

Be prepared for jet lag – Before pregnancy, I had little issues with jet lag, trying to get on local time as soon as possible. I discovered when flying back from the US to Turkey that it hits you much harder as a pregnant traveler, especially as you can’t use sleeping pills or alcohol to help you sleep. Factor this into your schedule and give yourself plenty of time to acclimate and adjust to time changes.

Realize your limits have changed – On a usual trip, I’d be up early to walk around a city all day, have a late lunch (or maybe just a big afternoon beer) followed by more museums and exploration, and still be up for checking out the local nightlife. Once pregnant, I required more sleep and three solid meals a day (plus maybe some snacks, I am eating for two!), tired after walking short distances, and was ready to call it a night long before last call. If you have an itinerary, pare it down to the must-sees and double the time to see everything; better to take it easy and enjoy your trip than feel exhausted and sick.

Look for destinations that don’t require vaccinations – One of the first tests your doctor will give you after confirming pregnancy will be for immunizations to hepatitis and rubella. If you haven’t had the vaccines, they will have to wait until after the baby is born as they are not safe for pregnant women. I have not had the hepatitis vaccine yet, and thus have a greater risk of contracting it, which rules out much of Africa and southeast Asia for travel, but also means I must avoid raw vegetables including salad in Istanbul. Most other medications and vaccines commonly given to travelers before going to an area prone to Malaria, Typhoid or Yellow Fever are not advised for pregnant women. But there’s still a big world out there, check the CDC for destination-specific information.

Be extra aware of food and water safety – Pregnant women are more susceptible to food poisoning the average person, as the immune system is suppressed so it doesn’t reject the fetus. This is the reason most pregnant women are told to avoid sushi and food that is not prepared in sanitized conditions. Even adventurous eaters should play it safe while pregnant and drink bottled water when in doubt. I recently had an opportunity to visit Mumbai, India but after consulting with a few friends who had lived there, I worried I’d spend the trip inside my hotel room eating pre-packaged food. Again,

check the CDC and use the same common sense you’d use anytime while traveling: stick with food that is freshly prepared in restaurants full of people.


Stay tuned for more on pregnancy travel, including Turkish superstitions and customs, travelling in the second trimester, where to do pre-baby shopping, and more on having a baby in a foreign country. Check here for further updates.

[Photo courtesy Mike Barish from the Istanbul tram]

Ask Gadling: You develop a serious illness while traveling

by Laurel Miller on

The very thought of acquiring a serious illness or injury while traveling strikes fear into the hearts of even the most stalwart adventurers. Speaking from personal experience, it’s terrifying to find yourself alone (or not) in dodgy accomodations, in a remote area of a developing country, with a raging fever and/or an uncontrollable case of the runs or other unsavory symptoms. Which isn’t to say the same ailments suffered in the comfort of a five-star hotel in Paris are a picnic, either. Any way you slice it, getting sick in a foreign country sucks.

And sometimes, despite taking precautions, you fall ill anyway, as I can attest. It can be a matter of circumstance (That water my guide “boiled” in a bamboo culm on a Thai Hilltribe trek? Yeah, I pretty much saw the resulting case of dysentery coming), or just bad luck. I’ve been on my own during most of my unfortunate on-the-road maladies. Between my experiences and those of fellow travelers, I’ve accumulated some wisdom over the years for dealing with sudden-onset illness in less-than-ideal circumstances.

For the purposes of this article, I’m not going to include injuries, pre-existing conditions, or focus on food poisoning, which was well-covered in a previous Ask Gadling post by Melanie. I also want to stress that we’re not medical professionals here at Gadling, myself included. For the technical stuff, I turned to Dr. John Szumowski, Clinical Fellow of University of Washington Medical Center’s Division of Allergy and Infectious Disease.

After the jump, tips on prevention, what to do when illness strikes, and how to get yourself home in the event of a full-blown medical emergency.

[Photo credit: Flickr user MoHotta18]

Before you leave home

Hit the internet
Do a bit of research on emergency medical options for a worst-case scenario. The U.S. Department of State produces a list of American doctors and hospitals in foreign countries.

If you have specific questions (about, say, where to find the best dentists in Europe), Lonely Planet’s Thorn Tree travel forum can be a useful place to get ideas (please do additional research before following any advice). Take the diagnostic-related questions directed to forum members with a heaping grain of salt, and save them for your doctor.

Get vaccinated
Check the CDC’s (Centers for Disease Control and Prevention) website to see what, if any, vaccinations you need before your trip. You can also get updates on things like outbreaks of cholera or bird flu. Be sure you allow ample time before your trip for the protective effects of vaccines to establish themselves. Dr. Szumowski also recommends the CDC’s “Survival Guide to Safe and Healthy Travel” webpage.

View more Ask Gadling: Travel Advice from an Expert or send your question to ask [at] gadling [dot] com.

Keep an immunization card on you (some countries require proof of certain vaccinations) as well as an online record, like Google Health.

All travelers should get flu and tetanus shots. If you’re a frequent world traveler, get vaccinated for hepatitis A, typhoid, and polio. Depending upon where you’re traveling, you may require a Yellow Fever or Japanese Encephalitis vaccine, or malaria prophylaxis.

I used to think a rabies vaccination was overkill until I saw a fellow traveler get seriously nipped by a puppy we were playing with in a remote village near the Myanmar border. The deathly silence that followed was sufficient motivation. Adds Dr. Szumowski, “It’s still important to remember that excellent wound-care and post-bite medical evaluation are necessary, even if a person has had prior rabies pre-exposure vaccination.” The International Society of Travel Medicine has a list of global travel medicine clinics.

I also carry an EpiPen, because you never know what could trigger anaphylaxis while you’re abroad. It also bears mentioning that you can develop a life-threatening allergy to something previously benign. A chef I know went into anaphylactic shock after tasting one of his dishes containing taro root, even though he’d been cooking with it for over 20 years.

If you get sick

Stay calm, and assess your symtoms
It’s easy to get carried away and assume the worst, but odds are your sudden fever isn’t malaria.

Try to identify the source of infection or illness

Know when to seek professional medical assistance
In general, says Dr. Szumowski, some symptoms or exposures that should prompt “expeditious” medical evaluation include:

  • high fevers (over 101ºF, especially if sustained or accompanied by shaking or drenching sweats)
  • bloody diarrhea
  • inability to keep food or liquids down in situation of significant vomiting or diarrhea
  • confusion or severe headache
  • severe cough, especially if accompanied by shortness of breath
  • animal bite or other animal-related attack

Tips for self-care

Stay hydrated
If you’re vomiting or have diarrhea, stay hydrated with (purified/bottled water), and Gatorade or other electrolyte beverages. If you absolutely have to travel, take Imodium as an anti-diarrheal.

Eat bland foods
Remember the BRAT diet for gastrointestinal upset: rice, bananas, applesauce, and toast.

Control your fever
To lower a high fever, take the recommended dosages of acetaminophen (Tylenol) or ibuprofen (Advil).

Wear ID
Wear a medical alert bracelet for serious conditions, allergies, etc., Write down your condition in your destination country’s language in both your phrasebook, and place a card in your passport.

Emergency Measures

Know when to self-diagnose
Sometimes, you find yourself in a position where you have no other option. That said, this is something you want to avoid for obvious reasons. Says Dr. Szumowski, “Self-diagnosis and treatment can be appropriate for less serious conditions such as traveler’s diarrhea, but it is important not to delay evaluation by a medical professional for more serious illness [see warning signs above]. If someone chooses to self-treat, it’s important to be aware of potential for counterfeit medications locally.”

What if the only available hospital/clinic/doctor’s office is seriously sketchy?
If you’re in a situation where the medical facility is primitive/lacking in sanitation, you’ve got a tough call on your hands.

I posed this question to Dr. Szumowski. He says, “It depends on the acuity and seriousness of the condition. In general, evaluation and treatment in a facility with adequately-trained staff and more comprehensive resources is preferable whenever possible–this may mean seeking evaluation in the capital, at a private hospital, or even returning home. Aside from limited diagnostics and medications, smaller/less-resourced facilities may have inadequate sanitary practices (e.g. reuse of equipment) and screening of blood products, raising the risk of contracting pathogens such as hepatitis C or HIV. Therefore, having evacuation insurance is advisable, especially for extended travels in the developing world.”

In other words, you may be shit out of luck. But this is why you’re reading this article–so you can be prepared for all kinds of situations! Read on.

OTC antibiotics
In many countries, you can buy OTC antibiotics, and indeed, this may be your only option, but heed Dr. Szumowski’s warning, above. Caveat emptor.

If you need to be evacuated, the U.S. government offers financial assistance and/or repatriation loans. The American Citizens Service and Crisis Management (ACS) is linked to U.S. embassies and consulates all over the globe. It’s a good idea to enroll in the U.S. Department of State’s “Smart Traveler Enrollment Program (formerly known as “Traveler Registration)” if you’re traveling for a long period of time, to a high-risk region, or doing any extreme adventure activities.

Travel prepared

Get antibiotic prescriptions (and carry copies with you) from your primary care doctor or internist, or visit a travel medicine clinic, and pack them in you travel first-aid kit (You don’t have one? REI has some great options). Some people also carry sterile latex gloves and hypodermic needles with them. If you’re diabetic or have another condition that requires injections, this makes sense, provided you have a note from your medical provider. For everyone else, this is a personal choice that comes down to, “How comfortable are you with the knowledge that you’re carrying drug paraphernalia?” If you backpack, travel in places with notoriously corrupt law enforcement, or countries like, say, Malaysia, you may want to hedge your bets.

Email yourself and family or a trusted friend copies of medical insurance, itinerary, and a list of medications, and doctors.

Consider traveler’s insurance.

If the worst happens

In the highly unlikely event you do come home with a mystery disease that isn’t responding to medical treatment, get to a specialist, asap. Depending upon where you’ve been, this may be an infectious disease or tropical medicine doctor, a dermatologist or rheumatologist who specializes in tropical medicine, etc.. You may need to travel–out of state–to find the right specialist. Find someone who has first-hand experience traveling/training or practicing in developing countries, and in diagnosing diseases not found in the U.S.. It may even be best to try and seek medical treatment in the country where you became ill (even if that means a return trip).

Unfortunately, I can speak with authority this subject, because I’m in my 22nd month of diagnostics following a trip to South America. If you do find yourself harboring a travel-related (or not) disease that defies diagnosis, you must be your own advocate. No one is more invested in your health than you are, and doctors are human. They may make mistakes, despite their best intentions. Seek not just a second, but a third opinion, from at least two different medical facilities.

And finally, don’t let anything in this article scare you and put you off travel. Odds are, you’ll come home with nothing more than great memories, and the eagerness to plan your next trip. I know I can’t wait.

[Photo credits: vaccination, Flickr user alvi2047; mosquito, Flickr user tonrulkens; toast, Flickr user snowriderguy; farmacia, Flickr user ibirque; drugs, Flickr user cavale]

Top five antibiotics to keep in your travel first aid kit

by Laurel Miller on

I’m not a doctor, nor do I play one on TV. But I do make my living off of eating while traveling which, if I have my way, usually entails sampling a lot of street food. That said, I do take precautions, but sometimes the inevitable happens anyway.

Back alley eateries aside, experienced adventurers know that it pays to visit a travel medicine clinic or their primary physician (an internist is best) before heading off the beaten path. I’ve learned through painful, sometimes embarrassing, experience to take a portable pharmacy with me when I travel, so I’m prepared when disaster strikes. Checking the Centers for Disease Control and Prevention site is a must when planning a trip to developing nations, so you can get the appropriate immunizations; plan far ahead, as some of these require months to take effect.

Please note that I’m not endorsing self-diagnosis, the purchase of dubious or over-the-counter pharmaceuticals, or the casual use of antibiotics. You can buy OTC meds in many countries, and I’ve had to do so more than once. But I wouldn’t recommend it unless it’s an emergency, you can’t get to a doctor, or the only medical assistance available is more high-risk than trying to diagnose and treat yourself.

Get legal prescriptions from your own doctor, one who hopefully understands tropical and/or travel medicine. Carry paper copies of your prescriptions with you, in case you find yourself subject to a random bag search (because life in a Thai prison isn’t fun, no matter what anyone tells you). For this reason, I don’t carry sterile syringes or hypodermic needles in my first-aid kit. If you’re diabetic or have a medical condition that requires injections, be sure to wear a medical alert bracelet and carry the appropriate paperwork on your person at all times.

I carry a small, nylon, wilderness first aid kit in my backpack. Besides the usual OTC stuff-hydrocortisone cream, antibiotic ointment, Airborne, ibuprofen, antihistamines, Imodium, and Pepto-Bismol tablets, my top five must-haves are listed below. Obviously, your list and doseages will vary based on your individual needs (I’m allergic to Penicillin), and you need to be extremely cautious about potential drug interactions, which is why you need a doctor to prescribe this stuff. All of these drugs are available in less-expensive generic forms.

1. Cipro: The big gun for serious bacterial infections
2. Doxycycline: a less expensive, less hardcore drug for bacterial infections, or for use in combination with other drugs for amoebic infections
3. Erythromycin: used for respiratory and streptococcal infections
4. Flagyl (metronidazole) for anaerobic bacterial, and certain parasitic infections
5. Gentomycin: an antibiotic eye ointment for stys, conjunctivitis, or other infections
6. Bonus round for women: Bactrim (for UTI’s, but also useful for GI infections), and Diflucan or Terazol (for yeast infections). If you’re traveling in the tropics or are withholding water consumption due to logistics (say, a 15-hour trip on a bus that has no toilet), you’ll be glad you have these on you. Trust me.

[Photo credit: Flickr user DawnVGilmorePhotography]

Don’t let illness wreck travel: Be prepared

by Jamie Rhein on

If you read Gadling’s travel series Catching the Travel Bug about being sick on the road, you found stories that attest to the fact that even seasoned travelers get sick from time to time. Travel to a new place and there are germs that your body is just not used to. But, if you’re prepared, whatever bug you catch won’t stick around to totally ruin a vacation or linger with continued health problems once you return.

Before you embark on a trip, make sure you’re immunizations are up to par. According to the World Health Organization, only 34% of the people who travel to places with hepatitis A get immunized against it. Dumb. When heading to places with malaria, only 8% take malaria prevention pills. Double dumb. The result of this neglect is that 30,000 travelers get malaria every year. Gad!

Considering that even a cold can put a damper on a vacation, malaria would do a real number. Typhoid wouldn’t be too swell either, another disease that’s preventable with a shot. In the Columbus Dispatch article where I read about this laxness towards immunization, one doctor told about a family who refused to get immunized when heading to a country in Africa known to be a high risk area. The teenage boy came home with typhoid as a result. He ate street food, and worse, drank local water.

In general, I think street food is not a problem if it’s being served cooked, it’s hot–meaning coming right off a grill, and you can see it being prepared, but local water? Nope.

Although getting immunized can add to the sticker price of a trip, it’s money well spent. Both malaria pills and immunizations have a certain time frame to be administered in order for them to be effective. If you’re planning on going to a country that is high risk where these treatments are recommended, don’t wait until it’s too late.

By the way, if you do get those shots, hang onto the record of when you got them. Some are good for several years so you can make the sticker price of shots go down by taking another trip to one of these locations before a shot expires.

Here is a link to a resource for what health details need to be taken care of before you travel to most African countries. And, here’s a link to the Centers for Disease Control and Prevention that has other travel health information.

Lariam Dreams (which pills do you pop?)

by Josh Lew on

If you’ve traveled to a tropical country, you’ve probably heard of Mefloquine. It is the most popular prophylactic against malaria, and is often sold under its trade name, Lariam. Lariam can have some serious side effects such as depression, anxiety, paranoia, nightmares and insomnia. You might say, “having nightmares is better than catching malaria and ending up in a hospital or worse.” I’m sure everyone would agree with that.

But when you wake up in a strange foreign land after a Lariam-induced nightmare…and you aren’t quite sure if you are really awake or if your waking state is just another extension of your dream, it can be pretty unnerving.

After such an experience, you might ask yourself if it is really necessary to ingest Mefloquine every time you enter a tropical region. I’ve known people who pop the little pills once a week when they are in Hong Kong or Singapore where the chance of catching malaria is akin to the chance that you will win the lottery. I guess some travelers choose to err on the side of caution when they enter any unfamiliar place.I haven’t even mentioned the host of shots and other pills that some guidebooks and doctors say you might want to consider. Typhoid is a big one. Cholera is another. Neither of these have vaccines that are 100% effective and they can bring about particularly nasty side effects. That doesn’t stop doctors from recommending them and people from getting the shots.

So what do you really need when you are traveling in a developing, tropical country? I guess it depends on how apprehensive you are. For me, Lariam and obscure vaccines are out unless I find that I am entering an area where a particular disease is truly a threat (see the WHO web site if you want to research a country you plan to visit). I also keep up to date on basic immunizations like tetanus and Hep B. And keep in mind, no matter how Lariam happy you get, there are diseases like SARS and H5N1 out there to remind us that health concerns are always going to be a scary part of traveling. And so I ask you, Gadling readers: what do you consider a necessary part of your travel-sized medicine cabinet?