Intended for healthcare professionals

Practice 10-Minute Consultation

Altitude sickness and acetazolamide

BMJ 2018; 361 doi: (Published 31 May 2018) Cite this as: BMJ 2018;361:k2153

The International Mountaineering and Climbing Federation Have Issued Specific Guidance for Pregnant Altitude Tourists

The work of Williamson et al. is informative and clinically useful(1). However, the victory of Serena Williams in the Australian Open whilst 8 weeks pregnant, in 2017, epitomises the fact that pregnant women must not be excluded in any discussion of the health effects of recreational activities in adults(2). With this in mind it is important to emphasise that the Medical Commission of the International Mountaineering and Climbing Federation (UIAA) has released important and specific guidance for women and the pregnant altitude traveller(3). Clinicians counselling altitude tourists must be aware of this guidance as it provides relevant and tailored information on means of optimising health and avoiding adverse effects of altitude. Williamson et al correctly highlight the fact that acetazolamide is relatively contraindicated in pregnant women(1). However in addition there exist peculiar considerations for woman and the child in utero during ascent to altitude. With specific reference to pregnant altitude travellers, the UIAA guidance advises that the risk to mother and child is low in the first half of pregnancy(3). However, as a precaution, women with difficulty in conceiving or at risk of spontaneous abortion avoid altitude even in this early stage. In the second half of pregnancy the risk is low for uncomplicated pregnancies up to 2500m(3). The recommendations do however advocate 3-4 days of acclimatisation before exercise at altitudes above 2500m(3). In addition altitude tourism is not recommended for woman after 20 weeks gestation, with the following conditions
Chronic or pregnancy-induced hypertension
Impaired placental function (ultrasound diagnosis)
Intra-uterine growth retardation
Maternal heart or lung disease
The general advice for the altitude novice can not be applied in an unqualified form to pregnant travellers.

1. Williamson J, Oakeshott P, Dallimore J. Altitude sickness and acetazolamide. BMJ. 2018 May 31;361:k2153.
2. Gregg VH, Ferguson JE 2nd. Exercise in Pregnancy. Clin Sports Med. 2017 Oct;36(4):741-752.

Competing interests: No competing interests

09 June 2018
Chika Uzoigwe
Ameet Kumar, Shoaib Khan
Harcourt House Sheffield
Harcourt House, Sheffield