Travel during Pregnancy: A Web-Based Survey of People Who Have Been Pregnant within the Past 10 Years

In the introduction, it was mentioned that there are other studies about traveling when pregnant. I suggest that those studies be discussed in the introduction, and if relevant, compare their results to your results.

Thank you. We have added a brief summary of prior studies here. In the discussion we compare our findings to prior studies.

Text added: “We previously queried travel practices among a limited population of people delivering in Madison, Wisconsin, USA during the Zika epidemic.[2], [3] One study queried travel during the first half of pregnancy and we found that around 5% of respondants had traveled internationally and around 40% had traveled domestically.[3] A second study queried postpartum people about travel through their whole pregnancy and we found that about 11% had traveled internationally and around 75% had traveled domestically.[2]”

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I wonder if a respondent can remember all of the 60-mile trips that they took up to 10 years ago. In the Western United States, a 60-mile trip can be a daily commute. 

Thank you. This is a valid point. We have added this as a limitation.

Text added: “People may not recall every domestic trip they took which exceeded 60 miles during a pregnancy up to ten years prior, for example.”

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On your flow diagram on Page 5, I suggest deleting "n = 7" at the top of the second box. It is confusing and some readers may think 14 respondents were excluded. 

Thank you. We have updated this.

On Page 6, Lines 129-130, I wonder if entire countries are one color or individual states. It might be interesting to see the different number of participants per state in the United States since the majority of the participants were from the United States.

Thank you. This particular question was not asked. We know the majority of respondents appeared to live within Wisconsin based upon the distance travelled to domestic destinations which were listed to be within Wisconsin, but we did not happen to query the state of residence during the pregnancy. This would have indeed been interesting to know. We asked about the country resided in during the pregnancy but not the state.

In the text of the results, I suggest indicating how race and location (urban/rural) were significantly different.

Thank you.

Text: “There were racial differences between domestic travelers and non-travelers (P=0.005). The annual income of domestic travelers differed from non-travelers with higher incomes associated with domestic travel (P=0.010). There were also rural-urban differences (P=0.032).”

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Is it known how many trips, on average, most respondents took?

Thank you.

We have added the following text: ”Overall 83.2% of participants took at least one domestic trip during their most recent pregnancy; 63.8% took two domestic trips, 44.6% took three domestic trips, 23.9% took four domestic trips, and 15.8% took five or more domestic trips.”

We have also added the following text: “Overall, 24.3% of participants took at least one international trip during their most recent pregnancy; 4.9% took two international trips, 2.1% took three international trips, 1.1% took four international trips, and 0.4% took five or more international trips.”

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Did they only respond about vacations or did they respond about travel they did in everyday life. For example, did they count driving over 60 miles to a soccer game for an older child?

Thank you. We did inquire about the reasons for travel. 

“Regarding the reasons for travel, most respondents traveled domestically for vacation (91.3%), followed by familial reasons (77.1%). (Table 4). Similarly, most respondents traveled internationally for vacation (94.6%), followed by familial reasons (78.5%).” And Table 4

Some people traveled specifically to attend medical appointments, such as referrals for needed fetal surgery or to attend specialist clinics that were not located within 60 miles of where they lived.

Page 10, Lines 159 - 167: It would be helpful to know the average percentage of pregnancies that end with a miscarriage. 

Thank you. We have added the following:

“Here we similarly found that pregnancy outcomes were overall favorable with outcomes such as preterm birth[39] and miscarriage[40] about the same[39] as and slightly lower[40] than in the general population, respectively, which was likely related to the population sampled and this being a retrospective study.:

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In Line 235, it is mentioned that "Given the risks of travel and transportation...". However, the data does not seem to indicate that travel is risky. The same has been found for other studies.I would agree that there are some risks in traveling, but do those risks exceed those of people who are not pregnant?

Thank you. We’ve clarified that travel is generally safe but that there are some scenarios that can be unsafe and have added a reference with a list of such scenarios (placenta previa/ accreta, etc.)

“Travel during pregnancy is generally safe. However, there are some risks of travel and transportation in some obstetric scenarios,[4]”

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