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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.
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