CLINICAL ACTIONS:

Occasional air travel during pregnancy is generally safe but is not recommended for women who have medical or obstetric conditions that may be exacerbated by flight or that could require emergency care. If a pregnant patient does opt to fly, consider the following discussion points:

• Use a seat belt continuously while seated to avoid turbulence-induced trauma
  • Ensure that the belt sits low on the hip bones between the protuberant abdomen and the pelvis
• Avoid gas-producing food or drink before flying to decrease general discomfort as entrapped gasses will expand at higher altitudes
• Consider preventive antiemetic medication especially for those women experiencing nausea
• Noise and vibration are a negligible risk
• Cosmic radiation is a negligible risk
  • National Council on Radiation Protection and Measurements and the International Commission on Radiological Protection recommend a maximum annual radiation exposure limit of 1 millisievert (mSv) (100 rem) for general public and 1 mSv over the course of a 40-week pregnancy
  • The longest intercontinental flight will not exceed 15% of this limit
• Check with the individual carrier for specific airline requirements as policies may vary
• Pregnant civilian and military air crew members should check with their specific agencies for regulations and/or restrictions on their flying duties

Note: ACOG has updated guidance regarding aircrew and frequent flyers and provides the following statement

The Federal Aviation Administration and the International Commission on Radiological Protection consider aircrew to be occupationally exposed to ionizing radiation and recommend that they be informed about radiation exposure and health risks

• The Federal Aviation Administration (FAA) has a document (see ‘Learn More – Primary Sources’ below) that provides tables and links to websites to aid in the calculation of effective dose of galactic cosmic radiation by a crewmember while inflight
  • The document also includes tables that provide risks for severe genetics defects
• The CDC also has a site with a section for aircrew (see ‘Primary Sources – Learn More’ below)

SYNOPSIS:

Most commercial airlines allow pregnant women to fly up to 36 weeks of gestation. However, some airlines restrict pregnant women from international flights earlier in gestation and some require documentation of gestational age.  Changes in vital signs (increased maternal heart rate, increased blood pressure, decreased aerobic capacity) may result due to cabin pressure and humidity levels alterations.

KEY POINTS:

• The following preventative measures can be used to minimize the risk of lower extremity edema and venous thromboembolic events
  • Support stockings
  • Periodic movement of the lower extremities
  • Occasional ambulation during flight
  • Avoiding restrictive clothing
  • Ensuring adequate hydration

Learn More – Primary Sources:

ACOG Committee opinion 746: Air Travel During Pregnancy

FAA: What Aircrews Should Know About Their Occupational Exposure to Ionizing Radiation

US Department of Transportation Advisory Circular: In-Flight Radiation Exposure

CDC: Cosmic Ionizing Radiation

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