Travel health update

In this special travel health update, Jane focuses on advice for women who are pregnant when travelling, or who are contemplating pregancy - plus some recommendations to make travel less stressful for any woman

TRAVEL ADVICE SPECIFIC TO WOMEN

The Royal College of Obstetricians and Gynaecologists (RCOG) has updated its document Air travel and pregnancy, which is a very useful leaflet to give to your patients in this situation. Topics covered include facts on whether or not flying will harm the baby; when the safest time to fly during pregnancy is; information about the airport security scanners; use of aircraft seatbelts; increased risk of problems such as deep vein thrombosis. For example, the leaflet advises the pregnant traveller she may develop leg oedema, nasal congestion or ear problems as a blocked nose is more likely during pregnancy, and explains that changes in air pressure in the plane can lead to these problems. If motion sickness is experienced during the flight, this can make pregnancy sickness worse. The leaflet goes on to relate when it may be advisable not to fly: if at increased risk of going into labour early, if a pregnant woman has severe anaemia or sickle cell disease with a recent sickle crisis, recent vaginal bleeding or a serious medical condition that makes breathing difficult. Resources at the end of the leaflet lead to the Scientific Impact Paper which contains a full list of the sources of evidence to create this patient leaflet. See http://goo.gl/u6sd7N

Although mentioned briefly in the December update, the RCOG has also recently updated its Malaria and pregnancy, available at http://goo.gl/3N69dc. This states that a pregnant woman should only travel to a malaria-risk country when the trip is essential – this is a useful statement to point out and document you have advised as such. The RCOG leaflet also gives clear instructions regarding the ABCD of malaria prevention advice, including advice to use an insect repellent containing 50% DEET and to apply it after a sunscreen; warns that antimalarial medication bought in a malaria-risk area and/or over the internet may be cheaper but may also be fake; explains to the traveller the symptoms of malaria, how malaria is diagnosed and how it is treated during pregnancy. There is also a small section on planning to get pregnant which includes the warning that it may be harmful to the baby if antimalarial medication is taken at the time of conception, and that a woman should wait until the drugs are out of her body before trying to get pregnant, specifying a wait of 3 months after completing mefloquine, 2 weeks for atovaquone proguanil and 1 week for doxycycline.

The Foreign and Commonwealth Office provides sensible advice for women travellers at http://goo.gl/9fmPwC, which also gives links to other helpful resources. Forced marriage is one of the topics addressed by this government department. Taking someone overseas to force them to marry is illegal and can result in a prison sentence of up to 7 years (http://goo.gl/hGF7xb). Female genital mutilation is also illegal, and carries a 14 year prison sentence. Intending to procure FGM may be the reason for taking a female child or young adult on a trip abroad, and this is something we should all be vigilant for in the travel consultation. (http://goo.gl/QFncbf)

Safety and security for the female traveller is another important topic to discuss. For example, wearing a ring on the wedding finger can help the female traveller to avoid harassment. Apps are now available to promote safety, and some include the capability to raise the alarm in a dangerous situation. Search on the Apple App pages or on Google Play for titles such as Circle of 6, bSafe, Guardly and CRF – Safer travel.

Useful resources for the female traveller to make her journey more comfortable, include information about the female urination device, the Shewee at www.shewee.com or Whiz Freedom at http://whizproducts.co.uk/, the menstrual cup at http://www.mooncup.co.uk/ Links to all the above resources can also be found at http://www.janechiodini.co.uk/news/help/