Can I go on a cruise while pregnant?

The verdict

Yes, and boat travel in itself is not restricted in pregnancy. What stops people is the operator's policy, and it kicks in earlier than almost anyone expects.

ACOG's travel guidance states that many cruise ships only allow you to travel until about 23 weeks of pregnancy, and that your ob-gyn can provide proof of your due date if needed. That is roughly the middle of pregnancy, and well before the flying cut-offs people are more familiar with.

The NHS gives different figures for ferries, which is a different kind of journey: ferry companies have their own restrictions and may refuse to carry heavily pregnant women, often beyond 32 weeks on standard crossings and 28 weeks on high-speed crossings. It advises checking the ferry company's policy before you book.

These are commercial decisions about what a vessel can handle, not statements about what is safe for you. It is worth understanding why they exist.

Why the cut-off is where it is

The limits are about the ship's medical facilities and its distance from a hospital, not about the sea.

Around 23 to 24 weeks is the threshold of viability, the point from which a baby born extremely early might survive with intensive neonatal care. A cruise ship's medical centre cannot provide that. It cannot provide an emergency caesarean with a neonatal team either, and a ship in the middle of an ocean may be many hours from a port with a suitable hospital.

Cruise lines therefore draw the line before the point where a delivery would need facilities they do not have. Ferries can afford later cut-offs because the crossing is short and both ends have hospitals.

ACOG's advice to check with the operator is the practical version. Policies vary between lines, and most require a doctor's or midwife's letter stating your due date and that you are fit to travel, dated within a defined window before sailing.

Seasickness, which is the thing people actually experience

ACOG identifies seasickness as one of the most common health problems for people taking a cruise, listing nausea, dizziness, weakness, headache and vomiting. It makes a sensible observation: if seasickness is not usually a problem for you, travelling by sea during pregnancy may not upset your stomach, but if you have never taken a cruise, planning your first one while you are pregnant may not be a good idea.

That is not a safety warning. It is advice about not discovering a new intolerance while already dealing with pregnancy nausea.

Motion sickness remedies are medicines, and which ones are appropriate in pregnancy is a question for a pharmacist, GP or midwife rather than for this page. Non-drug measures that are not medicines at all include staying midship and low down where movement is least, keeping your eyes on the horizon, staying on deck in fresh air, and eating small amounts regularly rather than nothing.

Norovirus and the food on board

Cruise ships have a specific reputation for gastrointestinal outbreaks, and it is deserved. Norovirus spreads readily wherever large numbers of people share dining rooms, handrails and lifts for days at a time, and a ship is a closed system.

The relevant pregnancy point is not that these infections cross the placenta, because norovirus does not. It is that severe vomiting and diarrhoea in pregnancy causes dehydration faster and matters more, and that you are confined to a ship while it happens.

ACOG's advice for staying healthy on a cruise is to plan to wash your hands often with soap and water and to pack hand sanitiser containing at least 60 percent alcohol for when you cannot.

The buffet is the other consideration, and it is a listeria question rather than a norovirus one. FSANZ lists pre-prepared or pre-packaged fruit or vegetable salads, including those from buffets and salad bars, among the foods pregnant women should not eat. Cruise buffets are exactly this format: cold food held for long periods and repeatedly disturbed.

The FDA's guidance on eating out in pregnancy is the right frame for a ship: order food cooked and served hot, avoid the cold ready-to-eat items that carry listeria rules on land, and treat the buffet the same way you would treat a salad bar at home.

Practical planning

• Travel insurance is the item people get wrong. Many policies exclude pregnancy beyond a certain week, and medical evacuation from a ship is extremely expensive. Read the pregnancy clause rather than assuming.
• Carry your maternity notes. ACOG advises taking a copy of your health record and insurance information if travelling far from home, because anyone treating you will need to know how far along you are.
• Check the ports, not only the ship. ACOG notes that some countries require vaccination against diseases that may be present there, and that vaccines should be discussed with your ob-gyn before travel. Zika-affected destinations remain a specific reason to change an itinerary.
• Move around. The clot-prevention advice ACOG gives for long-distance travel, walking around regularly and considering compression stockings, applies on a ship as much as on a plane.
• Get the letter early. Midwives are used to writing these, but they need notice, and the letter usually has to be dated close to departure.

Smaller boats, day trips and ferries

Short crossings, harbour tours, canal boats and river trips are not covered by any of the above and are not restricted anywhere. The considerations are ordinary ones: a stable surface to walk on, somewhere to sit, and access to a toilet.

The exception is high-speed craft. The NHS notes the earlier 28-week cut-off on high-speed crossings, which reflects the harder ride rather than the distance. Rigid inflatable boat trips and speedboat rides involve repeated impact, and that is closer to the sort of activity ACOG advises avoiding in its exercise guidance.

Where guidance differs

The numbers differ because the journeys differ. ACOG's roughly 23 weeks is about ocean cruises; the NHS's 32 and 28 weeks are about ferries. Neither contradicts the other.

Both put the decision with the operator. ACOG says travel companies including cruise operators have cutoff dates and may require proof of gestational age; the NHS says to check the ferry company's policy before booking.

Nobody says the sea itself is a risk. No health authority restricts boat travel in pregnancy on physiological grounds.

The food rules travel with you. The listeria rules that apply to salad bars and cold ready-to-eat food at home apply to a cruise buffet, and Australia's list is stricter than the UK's on prepared salads.