Travel vaccines and malaria tablets in pregnancy

Some travel vaccines are safe in pregnancy and some aren’t, and malaria is a serious risk. Here’s what the NHS and TravelHealthPro say.

The simplest advice

The NHS says it’s best to avoid visiting countries or areas where travel vaccinations are needed while you’re pregnant. If you can’t avoid it, talk to your midwife or GP about the risks and benefits. The NHS also says that in high-risk areas, it’s often safer to have a vaccine than to travel unprotected.

Live and non-live vaccines

Non-live (inactivated) vaccines cannot copy themselves in your body. TravelHealthPro says pregnancy should not stop you having them if they are medically needed.
Live vaccines contain a weakened form of the germ. TravelHealthPro says most are contraindicated or not recommended in pregnancy, and you need specialist advice if travel is essential. The NHS lists BCG, MMR, oral typhoid and yellow fever as live vaccines, and says there’s no evidence any live vaccine causes birth defects. It also says there is a potential risk that a live vaccine could infect the unborn baby, so they are usually advised to wait until after the birth, but one may be used in pregnancy if the risk of infection is greater.

For some diseases there is more than one type of vaccine, so ask the clinic which type they’re offering you. TravelHealthPro advises delaying conception for 28 days after a live vaccine, which matters if you’re planning another pregnancy.

Yellow fever

TravelHealthPro says yellow fever vaccination should generally be avoided in pregnancy, on theoretical grounds. If travel to a high-risk area can’t be avoided, it says the vaccine can be considered after an individual risk assessment. The NHS says it may be thought necessary. Your clinic can also tell you whether a country actually requires the vaccine for entry.

Dengue

TravelHealthPro says the dengue vaccine Qdenga is contraindicated in pregnancy and breastfeeding, and that people who could become pregnant should avoid pregnancy for at least one month after it.

Malaria

TravelHealthPro says pregnant women are at greater risk of severe malaria and advises avoiding travel to malaria-risk areas. Fit for Travel says the same for non-essential travel. If you can’t avoid it, ask your GP for advice early and use what TravelHealthPro calls the ABCD approach:

Awareness of the risk
Bite prevention, including repellent with 50% DEET
Chemoprophylaxis (malaria tablets)
Diagnosis and treatment without delay if you get symptoms

The NHS says some anti-malaria tablets aren’t safe in pregnancy. TravelHealthPro’s summary:

Chloroquine is safe in all trimesters but often doesn’t work because of resistance.
Mefloquine can be used in all trimesters, with caution in the first.
Doxycycline is generally avoided.
Atovaquone-proguanil is generally not advised, but may be considered in the second and third trimesters if there is no other option, with 5mg of folic acid a day.

Which tablet is right depends on where you’re going and how far along you are. That’s a decision for a specialist, not something to work out yourself.

Zika and other mosquito-borne illnesses

TravelHealthPro advises postponing non-essential travel to Zika outbreak areas, and says to contact your GP or midwife if you visited a risk area while pregnant. See Zika virus and pregnancy.

Vaccines to have at home

Whooping cough, flu and RSV vaccines are offered in pregnancy by the NHS. See whooping cough, flu and RSV vaccines in pregnancy.

When to get advice

Speak to your GP, midwife or a travel clinic as early as you can before you go, because some courses take time. If you get a fever or flu-like symptoms during or after a trip to a malaria area, get medical help straight away and say you’ve been abroad.

When to get help

If you’re pregnant and you have any bleeding or spotting, contact your maternity unit, an early pregnancy unit (if you’re under 20 weeks) or NHS 111. Call 999 if the bleeding is heavy or the pain is severe, or if you have a sharp, sudden, intense pain in your tummy and feel very dizzy or faint, feel sick, or look very pale. If you’re abroad, use the local emergency number and ask for medical help.

If your baby’s movements slow down, stop or change, call your midwife or maternity unit straight away, day or night. Don’t wait until the next day, and don’t use a home doppler to check the heartbeat, because hearing a heartbeat doesn’t mean your baby is well. If you’re abroad, go to a local maternity unit or hospital.

Questions people ask

Can I have travel vaccines when pregnant?

Non-live vaccines can be given if medically needed. Most live vaccines are not recommended. The NHS says to speak to your midwife or GP, and TravelHealthPro says to get specialist advice if travel is essential.

Is the yellow fever vaccine safe in pregnancy?

TravelHealthPro says it should generally be avoided, but it can be considered after an individual risk assessment if you can’t avoid a high-risk area.

Which malaria tablets can I take?

It depends on where you’re going and your stage of pregnancy. The NHS says some aren’t safe. Ask your GP or a travel clinic, and avoid malaria areas if you can.

Is insect repellent safe in pregnancy?

TravelHealthPro says pregnant women in malaria areas should use an insect repellent containing 50% DEET, taking care to avoid swallowing it. Ask a pharmacist or travel clinic if you’re unsure.