Whilst the effect of altitude on an unborn baby is the primary concern of pregnant women, when discussing the potential risks of trekking in Nepal, other health issues relevant to pregnant women must not be overlooked. This includes long haul air travel, traveling in remote areas, lack of adequate medical infrastructure in the country, illnesses like diarrhea and other related travel illnesses. With the aim of minimizing the risk to mother and unborn child, the following article is intended to help pregnant women decide on whether to travel to Nepal and how to plan their holiday having decided to spend some time here.
Air travel during pregnancy
The two main concerns of air travel in pregnancy are the effects of low oxygen and the effect of cosmic radiation on the unborn child. There is good experimental evidence that the low oxygen content of the inside of an airplane does not interfere with the oxygen delivery to the unborn baby as measured using fetal heart monitoring during flight. There is no evidence that babies are harmed by long haul air travel. For most casual air travelers, the effects of cosmic radiation on developing babies is said to be negligible. Most airlines continue to allow pregnant cabin crew to work . The following are reasons for considering not flying whilst pregnant:
- A previous history of miscarriage or premature labor/delivery
- Severe anemia
- Uncontrolled blood pressure
- A previous history of ectopic pregnancy and lack of confirmation as to the site of the current pregnancy. (You should confirm that the pregnancy is sited in the womb and not elsewhere – usually a scan is required).
- A previous history of a blood clot in the leg or the lung.
Note: Most airlines will not allow pregnant women on a plane beyond 32 weeks. Thai airways will usually allow women to fly to Bangkok from Kathmandu at 36 weeks, as long as they have a letter from an obstetrician stating they are well and unlikely to deliver on the plane. An accompanying letter is mandatory for all pregnant women traveling by air.
Altitude and pregnancy
There is limited information available about the effect of short-term exposure to high altitude on pregnant women and their unborn babies. Most data available is on the effect of moderate altitude e.g. in pregnant airline crew who fly at relatively higher altitude ( up to 8000ft or 2438 m) on a regular basis and do fine with their pregnancies. An unborn baby or the fetus is expected to tolerate some degree of having low oxygen quite well e.g up to the altitude of 12000 ft or 3650m since the fetus routinely lives in a relatively hypoxic (having less oxygen) environment. Also, the female hormone progesterone which is in abundance in pregnancy is supposed to stimulate breathing which helps to adapt the pregnant woman to high altitude by bringing more oxygen to the body. Acclimatization to altitude is genetically determined and it is not possible to predict how well an individual, pregnant or not will respond to high altitude. Pregnant women should definitely not get into the situation of developing acute mountain sickness (AMS) or the more severe complications like high altitude cerebral or pulmonary edema (HACE or HAPE).
Long term exposure to altitude while pregnant has been shown to retard fetal growth in high altitude residents but not so in persons who are genetically protected e.g. the Tibetans or the Andeans. Fetal growth retardation will not be a problem in short term pregnant visitors.
Other considerations for the pregnant trekker
Trekking in Nepal takes you into remote regions, some more so than others. The two most popular trekking regions of Khumbu and the Manang valley in the Annapurna region have health posts staffed by western doctors during the trekking seasons. They are positioned in two areas where the risk of altitude sickness is high but they can also deal with other medical emergencies. Virtually no other health facilities exist in any other trekking area and the only other available medical support would be from a passing doctor or through evacuation to Kathmandu. The lack of medical support on most trekking routes must be considered by pregnant women planning a trek.
Diarrhea: (see the articles on diarrhea in Nepal)
The most common travel related illness, it almost certainly will happen to you during a visit to Nepal. The antibiotic of the quinolone group e.g.ciprofloxacin that is effective in treating diarrhea is contra-indicated in pregnancy so pregnant women need to pay meticulous attention to maintaining their hydration. As mentioned above, dehydration can lead to increased risk of complications and diarrhea at altitude is fairly effective at causing dehydration, especially if vomiting is also present.
This is a disease caused by a virus that results in inflammation of the liver leading to jaundice. It is very like Hepatitis A with one exception, it seems to be particularly dangerous to pregnant women. There is no vaccine available (yet) and it is prevalent in Nepal. It is transmitted via the fecal-oral route i.e. by drinking contaminated water or eating contaminated food.
Trekking while pregnant carries with it a certain degree of risk for both mother and child. Altitude on its own may not necessarily pose the greatest threat; in fact there is good evidence to suggest that it is quite safe to spend a brief period at moderate altitude with the necessary time taken to acclimatize. There are however a host of other factors about trekking in Nepal that may conspire to make it a hazardous trip. The hills of Nepal are changing slowly but they will without doubt be worth visiting for a long time to come. Pregnancy is a temporary condition and if having had your baby, you still feel a strong pull to visit Nepal, it may be safer and more fun to do it with your young child (see “trekking with children”).
The following are situations where pregnant women would be wise to consider postponing a trekking trip to Nepal:
- Any woman with a history of miscarriage, especially during the first three months.
- Any woman with a concurrent medical condition or who smokes.
- Any woman pregnant for the first time.
- Any woman with a history of complicated pregnancy requiring hospital admission (except for delivery).
If you are determined to trek whilst pregnant there are a few things that are mandatory:
- Make sure you have had at least one scan and it has been confirmed the pregnancy is in the womb (beware a second pregnancy in one of the tubes), that the placenta is not “in the way” i.e. a placenta praevia.
- Make sure that you are not anemic or have high blood pressure and be sure that you are not developing diabetes. Have your urine checked for the presence of protein and sugar.
- Check you are immune to Rubella (German Measles). A rare disease in the West but not uncommon in Nepal as the MMR vaccine is not commonly taken up by the Nepalese. Rubella infection is very damaging to an unborn child.
- Make sure your ascent is slow and that you acclimatize well. Build in plenty of rest days, keep well hydrated and be prompt in your decision to descend if you are feeling unwell (see the articles on altitude sickness).
- Get the best medical insurance you can and make sure it covers you for evacuation off the trail and out of the country.
If you have any specific questions regarding pregnancy and trekking, please contact the clinic