Is international travel safe during pregnancy?

What does the evidence say about international travel during pregnancy?

1. Travel is considered safest in the second trimester, since the risk of obstetric complications is greatest in the first and third trimesters of pregnancy. 1
2. Many US health insurance policies don't cover the cost of medical care for pregnancy or newborn complications that happen outside the United States, so arranging supplemental coverage for pregnancy care and medical evacuation before you go is worth the planning time. 1
3. Live vaccines, including MMR and travel-specific options like typhoid and yellow fever, are generally avoided during pregnancy because of a small chance the vaccine itself could cause infection, while inactivated vaccines such as the flu shot, Tdap, and COVID-19 vaccine are recommended. 2
4. In a registry following pregnant travelers to Zika-affected areas, staying longer than two weeks, traveling during the peak epidemic period, and visiting the Caribbean were each independently linked to a meaningfully higher chance of infection compared with shorter or off-peak trips. 3
5. For malaria-endemic destinations, doxycycline is avoided in pregnancy due to a fetal tooth-discoloration risk and no malaria prophylaxis regimen is completely effective, which is part of why postponing travel to these areas is generally preferred; when travel can't be avoided, careful food and water choices, like avoiding water of unknown purity and unpeeled produce, also reduce the chance of travelers' diarrhea and hepatitis E. 4

Is international travel safe in each trimester?

• First trimester. The first trimester carries a higher risk of pregnancy complications while traveling, and it's also often when morning sickness is roughest, so a flexible trip is easier to plan for the second trimester if you have the option.
• Second trimester. This is generally considered the best window to travel: energy is often better, nausea has usually eased, and the risk of pregnancy complications is lower than in the other two trimesters.
• Third trimester. Risk of complications rises again in the third trimester, and international flights are often restricted earlier than domestic ones, sometimes well before 36 weeks, so confirm your specific airline's cutoff before booking.