Does air travel in commercial aircraft differ from military aircraft for pregnant women?

From the Guidelines

Flying while pregnant in a commercial aircraft is significantly different than flying in military aircraft due to the unique risks and conditions associated with military flights. The primary concern with flying during pregnancy is the risk of venous thromboembolism (VTE), which is increased with air travel, especially for flights longer than 4 hours 1. According to the American Society of Hematology 2018 guidelines, air travel is associated with a 2.8-fold increased risk for DVT or PE, with an estimated absolute risk for symptomatic DVT of ∼0.05% and for asymptomatic DVT of 2.6% for a 4-hour flight and 3.6% for a 7-hour flight 1. Pregnant women are already at a higher risk for VTE due to their condition, with an odds ratio (OR) for VTE of 4.3 compared to non-pregnant women, and this risk is multiplicatively increased with air travel, resulting in an OR of 14.3 for VTE in pregnant women who travel by air 1. Key differences between commercial and military aircraft include:

• Higher G-forces in military aircraft, which can increase the risk of placental abruption
• Unpressurized cabins in some military aircraft, which can lead to reduced oxygen levels for the fetus
• More extreme altitude changes in military flights, potentially affecting fetal development
• Increased noise and vibration in military aircraft, which may have developmental impacts on the fetus
• Potential exposure to hazardous materials in military flights Given these risks, pregnant women should avoid flying in military aircraft whenever possible and consult with their healthcare provider before any air travel. Commercial air travel is generally considered safer for pregnant women, but they should still take precautions such as staying hydrated, moving regularly during flight, and wearing seatbelts properly positioned below the abdomen.

From the Research

Differences in Flying While Pregnant

• There is no direct evidence to suggest that flying while pregnant in a commercial aircraft is different from flying in a military aircraft in terms of safety precautions for pregnant women 2.
• However, the type of aircraft and flight conditions may vary, which could potentially impact the level of turbulence and other factors that may affect pregnant women.
• The American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant women take precautions to minimize the risk of deep vein thrombosis (DVT) and other complications during air travel, such as wearing support stockings and moving regularly 2.

Prevention of Deep Vein Thrombosis

• Graduated compression stockings (GCS) have been shown to be effective in reducing the risk of DVT in hospitalized patients, including those undergoing surgery 3.
• However, the use of GCS in addition to low-molecular-weight heparin (LMWH) may not be necessary for all patients, and the decision to use GCS should be based on individual patient risk factors and medical history 4.
• The evidence for the use of GCS in preventing DVT in medical patients is limited, and more research is needed to determine its effectiveness in this population 3.

Air Travel and Pregnancy

• Pregnant women can fly safely, but they should take precautions to minimize the risk of complications, such as wearing their seatbelt continuously while seated and avoiding restrictive clothing 2.
• The Federal Aviation Administration and the International Commission on Radiological Protection recommend that aircrew and frequent flyers be informed about radiation exposure and health risks, but the risks to the fetus from exposure to cosmic radiation are generally considered to be negligible 2.