Compression Stockings for Pregnant Travelers: Recommendations for DVT Prevention
For pregnant travelers flying to Italy, compression stockings providing 15-30 mmHg pressure at the ankle are recommended to prevent deep vein thrombosis and pulmonary embolism. 1, 2
Risk Assessment for Pregnant Travelers
Pregnancy significantly increases the risk of venous thromboembolism (VTE):
- Pregnancy alone increases VTE risk 5-10 fold compared to non-pregnant women 3
- This risk increases to 20-80 fold during the postpartum period 3
- Air travel further compounds this risk, with long flights (>4 hours) associated with a 2.8-fold increased risk of DVT 1
Compression Stocking Recommendations
Pressure Level:
- 15-30 mmHg graduated compression stockings are the recommended pressure level for pregnant travelers 2
- This pressure range has been shown effective in clinical studies for preventing both edema and DVT 4, 5
Type and Application:
- Below-knee stockings are preferred for comfort and effectiveness
- Put on stockings 2-3 hours before the flight 2
- Ensure proper fit to avoid restricting circulation
- Wear throughout the entire flight and for 1-2 hours after landing
Additional Preventive Measures
Mobility:
- Take frequent walks in the cabin every 1-2 hours 2
- Perform calf muscle exercises when seated
- Request an aisle seat to facilitate movement
Hydration and Clothing:
- Increase fluid intake by 0.5-1 liter during travel 2
- Avoid alcohol and excessive caffeine
- Wear loose, comfortable clothing that doesn't restrict circulation
Risk Stratification for Additional Measures
High-Risk Pregnant Travelers (consider additional prophylaxis):
- Previous history of VTE
- Known thrombophilia
- Multiple risk factors (obesity, immobility)
- Late trimester pregnancy
For high-risk pregnant travelers, consider consulting with a healthcare provider before travel to assess if additional prophylactic measures such as low molecular weight heparin (LMWH) are needed 6.
Evidence Quality and Considerations
The European Society of Cardiology guidelines strongly recommend graduated compression stockings for all women at high risk of VTE during pregnancy, both antepartum and post-partum (Class I recommendation) 1. For intermediate-risk pregnant women, compression stockings should be considered (Class IIa recommendation) 1.
Studies specifically examining compression stockings during air travel have demonstrated:
- Significant reduction in edema scores (2.3 vs 6.9 in controls) 4
- Reduction in DVT incidence (0% vs 3-6% in controls) 4, 5
Common Pitfalls to Avoid
- Don't use incorrect pressure: Stockings with insufficient pressure (<15 mmHg) may not provide adequate protection
- Don't delay application: Put on stockings before the flight, not during
- Don't ignore symptoms: Monitor for signs of DVT (unilateral leg swelling, pain, redness)
- Don't rely on aspirin alone: Aspirin is not recommended specifically for DVT prevention during travel 2
Pregnant travelers should be informed about the signs and symptoms of VTE and the necessity to contact physicians if they occur 1.