Commercial Air Travel During Pregnancy: A Journey-based Systematic Review of Airport Security Screening, Cabin Environmental Exposure, Turbulence, Venous Thromboembolism, and Evidence-based Maternal–Fetal Safety Recommendations

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BSTRACT

Commercial air travel during pregnancy has become increasingly common, yet uncertainty regarding maternal–fetal safety persists among pregnant travelers and healthcare professionals. Existing reviews have generally examined individual issues, such as venous thromboembolism, cabin hypoxia, or radiation exposure, without integrating the sequence of exposures encountered throughout the travel journey. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 Statement to synthesize the available evidence from a journey-based clinical perspective, spanning airport security screening, aircraft cabin environmental conditions, prolonged immobility, turbulence, venous thromboembolism, and maternal–fetal outcomes. Electronic databases were systematically searched, and 33 eligible publications were included in a qualitative synthesis comprising observational studies, physiological investigations, epidemiological studies, narrative reviews, professional guidelines, and selected case reports. Routine airport security screening and occasional exposure to cosmic radiation during commercial flights were consistently associated with negligible fetal risk in uncomplicated pregnancies. Available evidence also indicated that healthy pregnant women generally tolerate mild cabin hypobaric hypoxia and reduced humidity through normal physiological adaptation, whereas those with significant cardiopulmonary disease, severe anemia, or high-risk obstetric conditions require individualized pretravel assessment. Across the reviewed literature, the strongest and most consistent evidence concerned the interaction between pregnancy-related hypercoagulability and prolonged immobility, supporting preventive strategies including hydration, periodic ambulation, and graduated compression stockings for appropriately selected women. Evidence linking turbulence to adverse obstetric outcomes remained limited and was derived largely from isolated case reports, emphasizing correct seat-belt use rather than routine travel restriction. Rather than introducing new biological evidence, this review proposes a journey-based framework that integrates previously fragmented literature into a clinically applicable approach for risk stratification and counseling. As a preliminary evidence synthesis intended to consolidate current knowledge and identify research gaps, the findings suggest that commercial air travel is generally well tolerated in uncomplicated pregnancies, although conclusions should be interpreted in light of the predominantly observational nature of the available evidence and the need for further prospective investigation.