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Travel Characteristics and Pretravel Health Care Among Pregnant or Breastfeeding U.S. Women Preparing for International Travel

Hagmann, Stefan H. F. MD, MSc; Rao, Sowmya R. PhD; LaRocque, Regina C. MD, MPH; Erskine, Stefanie MPH; Jentes, Emily S. PhD, MPH; Walker, Allison T. PhD, MPH; Barnett, Elizabeth D. MD; Chen, Lin H. MD; Hamer, Davidson H. MD; Ryan, Edward T. MDfor the Global TravEpiNet Consortium and the Boston Area Travel Medicine Network

doi: 10.1097/AOG.0000000000002360
Contents: Original Research

OBJECTIVE: To study characteristics and preventive interventions of adult pregnant and breastfeeding travelers seeking pretravel health care in the United States.

METHODS: This cross-sectional study analyzed data (2009–2014) of pregnant and breastfeeding travelers seen at U.S. travel clinics participating in Global TravEpiNet. Nonpregnant, nonbreastfeeding adult female travelers of childbearing age were used for comparison. We evaluated the prescription of malaria chemoprophylaxis and antibiotics for this population as well as the administration of three travel-related vaccines: hepatitis A, typhoid, and yellow fever. We also evaluated use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis and influenza vaccines, because these are widely recommended in pregnancy.

RESULTS: Of 21,138 female travelers of childbearing age in Global TravEpiNet, 170 (0.8%) were pregnant and 139 (0.7%) were breastfeeding. Many traveled to destinations endemic for mosquito-borne illnesses, including malaria (pregnant: 95%; breastfeeding: 94%), dengue (pregnant: 87%; breastfeeding: 81%), or yellow fever (pregnant: 35%; breastfeeding: 50%). Compared with nonpregnant, nonbreastfeeding adult female travelers, eligible pregnant travelers were less likely to be vaccinated against hepatitis A (28% compared with 51%, P<.001) and typhoid (35% compared with 74%, P<.001). More than 20% of eligible pregnant travelers did not receive influenza vaccination. Yellow fever vaccine was occasionally provided to pregnant and breastfeeding travelers traveling to countries entirely endemic for yellow fever (6 [20%] of 30 pregnant travelers and 18 [46%] of 39 breastfeeding travelers). Half of pregnant travelers and two thirds of breastfeeding travelers preparing to travel to malaria-holoendemic countries received a prescription for malaria prophylaxis.

CONCLUSION: Most pregnant and breastfeeding travelers seen for pretravel health consultations traveled to destinations with high risk for vector-borne or other travel-related diseases. Destination-specific preventive interventions were frequently underused.

Many pregnant or breastfeeding women who seek pretravel health advice travel to destinations with high risk for travel-related diseases and frequently underuse preventive interventions.

Division of Pediatric Infectious Diseases, Bronx Lebanon Hospital Center, Bronx, New York; the Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York; the Department of Surgery, Boston University Medical Center, Boston, Massachusetts; MGH Biostatistics Center and the Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts; the Department of Medicine, Harvard Medical School, Boston, Massachusetts; the Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; the Department of Pediatrics and the Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; the International Clinic, Boston Medical Center, Boston, Massachusetts; the Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge, Massachusetts; and the Department of Global Health, Boston University School of Public Health, Boston, Massachusetts.

Corresponding author: Stefan H. F. Hagmann, MD, MSc, Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center of New York, 269-01 76th Avenue, New Hyde Park, NY 11040; email: shagmann@northwell.edu.

* For a list of members of the Global TravEpiNet Consortium and the Boston Area Travel Medicine Network who contributed data to this study, see Appendix 1, available online at http://links.lww.com/AOG/B30.

Global TravEpiNet is supported by U01CK000490 and U01CK000175 from the U.S. Centers for Disease Control and Prevention.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Financial Disclosure Dr. Chen has been an advisor for Shoreland, Inc, and has received speaker travel support and an honorarium from GlaxoSmithKline. The other authors did not report any potential conflicts of interest.

Presented in part at the 14th Conference of the International Society of Travel Medicine, May 24–28, 2015, Quebec City, Canada.

Stefan H. F. Hagmann is presently affiliated with the Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York; and Hofstra Northwell School of Medicine, Hempstead, New York.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.