If you are traveling to almost any tropical country, it is likely you will need to protect yourself against malaria. This is a disease which was supposed to have been eradicated by now but instead is on the increase. Resistant forms of malaria have now spread to most of the tropical world.
Malaria is one of the most dreaded diseases during pregnancy, both for its frequency and its severity. Studies have shown a preference of malaria-bearing Anopheles mosquitoes for pregnant women. Whether this is due to the fact that in pregnancy you exhale more carbon dioxide or increased body surface temperature is a matter of conjecture. But the fact remains that a pregnant woman is more apt to get malaria than is her non-pregnant counterpart.
Further, her illness will likely be more severe. The number of parasites in the blood reaches much higher levels and results in an increased likelihood of cerebral malaria, anemia, low blood glucose levels and a relapse after usual treatment. Red blood corpuscles may “sludge” in the placenta and cause premature labor or separation of the placenta.
A baby born to a mother with malaria is more apt to be of low birth weight and to suffer from dehydration, seizures, bleeding disorders and rupture of the spleen.
Most people, when they speak of malaria prevention, immediately think of spraying with insecticide or taking medicines. The truth is that the first steps in malaria prevention are much more basic and consist of mosquito avoidance.
Remember that malaria is a parasite that infects both the liver and the blood. The various medicines to prevent the disease work on either the liver forms or the blood forms of the parasite. Some combination medicines do both.
When a pregnant woman actually gets malaria the treatment is often simply higher doses of the same drugs. There are also other medicines that are used for treatment but not used for prevention.
Traveler’s diarrhea becomes more of a threat during pregnancy. Not only is it more apt to occur, it is likely to be more severe, the consequences are more dangerous and the treatment more difficult.
Your body’s main defenses against traveler’s diarrhea are your immune system, the acid in your stomach and the rapid transit through the intestine. Antibodies and immune cells attack bacteria and viruses as soon as they enter your system. And as soon as bacteria reach your stomach, the acidity eats away at their cell membranes and renders most of them harmless. Those that escape are quickly hastened down the intestinal tract and out of your body.
All of these are affected when you are pregnant. In order not to “reject” the baby (as with a kidney transplant) the immune system is a little lax during pregnancy. And even though you may not think so when you are overwhelmed with heartburn, your stomach produces less acid when you are pregnant. Finally, as a side effect of the hormone progesterone, your intestines slow down. Thus, the germs that can cause diarrhea are not as efficiently killed or eliminated.
Further, because of other chemical changes that occur with pregnancy, diarrhea in a pregnant woman is more apt to lead rapidly to dehydration and acidosis. And acidosis in a pregnant woman can be fatal to the baby.
It is very important, therefore, that you do all you can to prevent the diarrhea and to treat it promptly and vigorously if it occurs. But before considering antibiotic or other medications, we recommend you contact us first.
Hepatitis and Pregnancy
Hepatitis is the medical word for an infection of the liver. Actually, hepatitis can be caused by drugs as well, but for the most part when we speak of it we mean a disease caused by viruses.
As you may have heard, there are several types of viral hepatitis, spread in several different ways. As new viruses are discovered that cause this disease, the alphabetical list of them keeps growing.
Hepatitis A is the main one we worry about in travelers. Although it is a mild illness in children, it can be devastating and life threatening in adults, especially pregnant women. A pregnant woman who gets hepatitis A is much more apt to get seriously ill, and the infection may cause premature labor or the premature separation of the placenta (abruption) resulting in a major hemorrhage and death of the baby.
Hepatitis B, the other common type of viral hepatitis, is spread through blood and body fluid contact. In some studies, as many as one out of sixty foreign travelers receive injections during their trip, many of them in countries where sterility of medical equipment is downright abysmal. Hepatitis B, too, is a very serious disease during pregnancy because it can cross the placenta and infect the baby. The baby may be infected for life, suffering permanent liver damage or even liver cancer.
Hepatitis C and D are both blood-borne, spread in the same fashion as hepatitis B and just as easily. But they are not as easily prevented because there is no vaccine against them.
Hepatitis E is quite new on the scene and it is rapidly becoming a worldwide disease. Like hepatitis A, it is spread in contaminated water. And it is devastating in pregnancy. In some epidemics, as many as half of the pregnant women who contracted the disease died of it.
Worms and Parasites
Intestinal parasites are not a fun topic to think about at any time, much less when you are pregnant. Nonetheless, if you will be traveling to underdeveloped areas and living and eating in places of questionable hygiene, infestation with these creatures becomes a real possibility.
In general, intestinal worms are rarely a severe enough health problem to warrant treatment during pregnancy. Most parasitic diseases, in fact, can safely be addressed simply with symptomatic treatment until the pregnancy is over.
An exception to this general rule may be infections with giardia, ameba and cryptosporidia. These may cause significant weight loss and diarrhea and result in a malnourished baby.
There are a few types of tapeworm that can end up in the liver, lungs, brain and other areas of the body. These are rare but may cause enough problems during pregnancy to warrant treatment.
Other parasites, rather than being spread through food, are injected by insects or can even enter directly through the skin. Infestation with these parasites can be quite dangerous in the long run, but usually there are few immediate effects.
Then, of course, there are the “ectoparasites”, like mites, scabies, lice, bedbugs and fleas. Prevention and treatment of these is best handled by insect repellents or possibly topical treatments. We can always advise you on these matters.
Although we hear a lot about traveler’s diarrhea, respiratory infections are almost as common in travelers as is diarrhea. And pregnant travelers are no exception.
Head colds, sore throats and sinus headaches are common. And when it is flu season, pregnant women often seem the most susceptible and get the most severe disease. Influenza in a pregnant woman can rapidly turn into pneumonia.
International travel, often including prolonged periods of being cooped up in a closed vehicle with many other people, is one of the risk factors for respiratory infections.
Urinary Tract Infections
Cystitis is an infection of the urinary tract and bladder. Drinking a lot of purified water, especially in hotter climates, may help to reduce your chances of suffering from this problem. This “lower” urinary tract infection is more likely in pregnancy to keep recurring or to never completely resolve, or even to spread to the upper urinary tract (when it is called pyelonephritis.)
Prevention and treatment of these infections is something we discuss in our personal consultations.
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