SCUBA Diving in Pregnancy

Objective: Obstetrical care providers may occasionally encounter women with questions about the safety of Self-Contained Underwater Breathing Apparatus (SCUBA) diving in pregnancy. This article provides an overview of safety issues associated with basic SCUBA diving and offers guidance to practitioners about how to evaluate and counsel pregnant women about the associated maternal and fetal risks. Basic diving physiology is reviewed and the implications of SCUBA diving during pregnancy are discussed. A literature review examined available animal and human data about the potential adverse effects of the physiological changes of pregnancy on divers, the impact of pressure changes during diving, and possible consequences of hyperbaric gas exposure and rapid decompression on mother and fetus. Data Sources: Studies were found by searching the terms "scuba diving," "pregnancy," "fetus," "decompression illness," "hyperbaric medicine," and "animal studies" in the databases Medline, Pubmed, and Embase. Reference lists from existing articles and reports from identified diving magazines were also reviewed. Studies were limited to the English language and included publications until 2016. Study Selection: All relevant human studies were selected. Five retrospective studies and one prospective study assessing the antenatal and postnatal outcomes of women who participated in SCUBA diving while pregnant were reviewed. Data Synthesis: Published data was limited in both quantity and quality. The authors' experience with SCUBA diving together with a background in obstetrics allowed themes to be explored and recommendations developed. Conclusions: In addition to established risks of SCUBA diving, pregnant women are at increased risk due to changes in body habitus (affecting equipment fitting and balance). Animal data suggest possible adverse fetal effects due to fetal decompression illness (DCI) and hyperbaric oxygen exposure. Human data, though generally reassuring, are of poor quality and thus do not completely exclude adverse outcomes. In general, women should be cautioned to avoid diving during pregnancy, but inadvertent exposure to recreational diving in early pregnancy is not a reason for pregnancy termination.