The use of acetazolamide is contra-indicated during the first trimester (risk of teratogenicity) and after 36 weeks of pregnancy (risk of severe neonatal jaundice). AMS incidence is not different during pregnancy.Immediate increase of maternal ventilation and cardiac output (with increase of uterine artery and placental blood flow) preserves, at best, oxygen delivery to the fetus. Physiological responses to altitude exposure So most of the recommendations can only be based on extrapolations. For pregnant women living normally at low altitude, very few studies have been made during acute exposure (hours) at moderate altitude, with or without exercise, and there is no known study conducted during prolonged exposure (days to weeks). Most studies concern women living permanently at HA. Some drugs useful for prophylaxis or treatment are contra-indicated during pregnancy: most antimalarials, quinolones, sulphonamide, and others.Infectious diseases can be more severe during pregnancy: especially diarrhoea, malaria, hepatitis E.Possibly a geat distance from medical/obstetrical assistance if/when needed.Risk of travelling in remote and exotic countries Ferritin dosage can be useful before expedition for supplementation if indicated. Latent iron deficiency can impede acclimatization at very high altitudes.The efficiency may also be compromised during and seven days after the use of some antibiotics, especially broad-spectrum penicillins and tetracyclines.It may be difficult to respect the exact time of administration during an expedition, compromising contraceptive efficiency.The risk is lower with the second-generation OCPs (versus first- or third- generation), which are recommended as a first choice at HA, but with these low-dosage pills two risks should be known: Actually very few accidents have been reported. The theoretical risk of oral contraceptives (except for progesterone alone) is thrombosis during long stays at HA, in combination with polycythemia, dehydration and cold.There is no proven advantage or disadvantage for altitude acclimatization when using oral contraceptives (OCPs).To avoid or significantly reduce bleeding, OCPs or progesterone (pills, medroxyprogesterone injections, or intrauterine device with hormone release (IUD)) can be taken continuously for several months (but spotting may occur during the first three months).Amongst other causes, and probably more important than altitude, it can be influenced by jet lag, exercise, cold, and weight loss. Menses can be modified by high altitude (HA): menstruation can be blocked up, longer, shorter, or irregular.Menses and peri-menopausal hypermenorrhoea Although progesterone increases hypoxic ventilatory response at sea level, there are no data that indicate a correlation between acclimatization to high altitude (HA) and menstrual cycle phases.There is no reported difference between men and women in the incidence of high-altitude cerebral edema (HACE).The incidence of peripheral oedema is higher in women than in men.The incidence of high-altitude pulmonary edema (HAPE) is lower in women than in men.There is no known difference between men and women in the incidence of AMS.
#High altitude series#
The tenth in our series exploring the UIAA MedCom’s high-altitude advice focuses on women going to altitude with specific advice for both pregnant and non-pregnant women. This paper was first produced in 2008 and is available in English, Czech, Dutch, German, Italian, Japanese, Persian, Polish, Portuguese, Russian and Spanish. In Featured, Mountain Medicine, Mountaineering
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