Pregnant Travelers
Travel may be safely done while pregnant, before the 28th week.

Malaria
At present, no real combination of effective drugs are approved for the prevention of Malaria in pregnant women. Chloroquine is considered safe but for areas that are Chloroquine resistant this would not be effective. Mefloquine, although not routinely given to pregnant women, has not been associated with adverse fetal or pregnancy outcome when given in

the 2nd or 3rd trimester.

Doxycycline is also not recommended since Tetracycline agents will stain the fetus's teeth and inhibits bone growth. Malarone also is not recommended.

At the present time it is recommended that pregnant women do not travel to Chloroquine resistant areas. If travel is unavoidable, avoiding mosquitoes at night, insect repellants and mosquito nets, are the best ways to prevent Malaria (and other insect caused diseases), although Mefloquine may be considered.

Malaria also causes a greater mortality in pregnant women and must be aggressively treated. Breastfeeding women may take Chloroquine, Mefloquine, and Malarone (If the baby weighs >25lbs)

DEET- is considered safe for pregnant women when properly used. There are no reports of Teratogenicity.

Hepatitis A & B
Hepatitis A

The Hepatitis A vaccine is safe in pregnancy. It is recommended when the benefits of preventing infection outweigh the risks of reviewing the vaccine.
Hepatitis A infection in pregnant women also causes a higher mortality. In summary, if a pregnant woman is traveling to an area where a Hepatitis A is common, they should receive the vaccination.


Hepatitis B

Hepatitis B is similar but the risk to casual tourists of infections is less and for shorter days. This vaccine may be deferred unless there is a very high risk.

Typhoid

The Typhoid VI vaccine is also safe in pregnancy but the live bacterial ty21a vaccine is not recommended.

Other vaccines that are not live may be safely given. These include: Tetanus, Diphtheria, Inactivated Polio Vaccine, IPV, Meningitis, and Rabies. Certain live vaccines should not be given to pregnant women. These include: Varicella (chicken pox), MMR (measles, mumps, rubella), JEV (Japanese encephalitis virus), and ty21a Typhoid. Yellow Fever vaccination may be given under certain circumstances.

Pregnant women also have a particularly high mortality when infected with Hepatitis E, which is similar to Hepatitis A in that it is acquired from food and water (unfortunately there is no vaccine for Hep E yet).

Traveler's Diarrhea
Traveler's Diarrhea may be very severe for pregnant women. Antacids, Tylenol, and Immodium, may be taken, but Pepto-Bismol should not be taken.
Antibiotics such as Septra, may be taken after the 12th week of pregnancy, but before the 3rd trimester.
Ciprofloxin, which is very effective for pregnant women, should not be used unless the risk of severe illness and dehydration is high. (Many Obstetricians prohibit Cipro under normal circumstances)

Azithromyin (Zithmax) may also be used and this is safe and effective in pregnancy. Nausea in pregnancy may be treated with Gravol, Meclazine, or Diclectin. It is important to distinguish if nausea is not simply early morning sickness (usually in the 1st trimester and then gets better) and not some other sickness. Ginger is also safe in pregnancy. Pregnant travelers may wish to check in accordance with the local Canadian Embassy and find where available clinics are located. Ongoing prenatal care may be hard to arrange, but follow-ups throughout pregnancy are strongly recommended.

In general, women near term or with problems during their pregnancy are not advised to travel unless cleared by their Obstetrician and if any kind of problems (especially bleeding) occur, they should seek immediate help.

The one vaccine that is always recommended for pregnant women is the Tetanus diphtheria (Td) shot even if they are carrying a normal pregnancy home in Canada. The IPV is sometimes added if they need additional coverage for Polio.