As you start your pregnancy journey, you will find that there are lots of tests that will be offered to you in the (roughly) 40 weeks leading up to your baby’s birth.
Here is everything you need to know about each of the tests that are covered by German public health insurance with expert information from midwife Amelie Suermann on what the tests mean and why they are recommended.
Amelie is a Berlin-based midwife with a Master of Science degree in Global Health. She works as one of the English-speaking midwives at Praxis Hebammenzeit in Friedrichshain. Amelie has a young daughter and is about to become a mom for the second time!
Here is an overview of the tests that are recommended for pregnant people in Germany
The recommendations are based on the “Mutterschaftsrichtlinien” (loosely translated to maternity protection guidelines) and are covered by public health insurance as it can be advantageous to know the results of these tests at an early stage. The tests will be documented in your Mutterpass.
There are also a few tests which are not covered by public health insurance and you can learn about those in our separate article.
(Please note that they are recommended but not required, so you can always ask for more information and then make your decision.)
Most of these tests that are offered at your first prenatal visit in Germany, unless otherwise noted:
HIV antibody test
It is recommended that every pregnant person in Germany is tested for HIV antibodies at your first pregnancy exam as anyone could have an undetected HIV infection without knowing it.
As the test result is confidential, it will only be marked whether or not your gynecologist or midwife took the test. They would certainly contact you in case of a positive result, and refer you to specialized doctors for further care.
If the test is positive, the likelihood of an HIV transmission to the child can be significantly lowered by the use of effective therapeutic measures.
This test is covered by public health insurance.
Chlamydia
The examination for chlamydia is carried out on a urine sample. The reason for this test is that an untreated infection with chlamydia during pregnancy and childbirth can be dangerous and can also be transmitted to the baby during the birth process.
A positive test result can be associated with a higher rate of miscarriage, stillbirths and urinary tract infections. It is therefore highly recommended to test and treat an infection, if positive.
This test is covered by public health insurance.
Syphilis (lues)
For this test, your blood sample will be tested for antibodies against syphilis. The reason for this test is that an untreated infection with syphilis during pregnancy can cause various pregnancy complications, such as miscarriage or stillbirth and can also be transmitted to the baby.
This test is covered by public health insurance.
Maternal blood group and Rhesus factor D
In the very beginning of your pregnancy, your blood type will be determined, along with a search for regular and irregular antibodies. The antibody test will be repeated between pregnancy weeks 27 and 30.
The rhesus factor RhD is an important blood group characteristic that is either present or absent on the surface of the blood cells, making that person Rh positive or Rh negative If a small amount of fetal blood cells of a Rh positive fetus is transmitted to the bloodstream of a Rh negative mother during pregnancy or birth, it may lead to health problems for the baby in a subsequent pregnancy.
This test is covered by public health insurance.
If a person is pregnant with just one baby and RhD-negative, they will be offered a test to determine the fetal rhesus factor. This can be done as early as pregnancy week 11 via a non-invasive blood test.
If the baby tests Rh positive, a standard dose (around 300 µg) of anti-D immunoglobulin should be injected between pregnancy weeks 27 and 30 (and shortly after birth) to prevent sensitization of the woman. This also applies in the case of a miscarriage and if there is bleeding during pregnancy.
The anti D prophylaxis is not necessary if the fetus has been determined to be RHD-negative or if the RhD-negative pregnant woman with RHD-positive fetus has already developed antibodies.
Hepatitis B
An antibody screening test for the hepatitis B virus antigen (HBsAg) is recommended to every pregnant person, as the likelihood of hepatitis B transmission to the child is significantly reduced by effective therapeutic measures.
As of June 2023, this test will be run in the first trimester (before it was done in the third trimester). This is because there is strong evidence for the effective antiviral treatment during pregnancy and because transmission during pregnancy is very rare.
(The current version of the Mutterpass still shows this test to be done during the third trimester but the next print edition will be updated according to the new recommendations.)
If the result of the hepatitis B test is positive, the pregnant woman should be treated and the newborn should be actively/passively immunized against hepatitis B immediately after birth.
This test is not required if immunity (e.g., after vaccination) has been demonstrated.
Non-vaccinated healthy pregnant women who are at increased risk of exposure will likely be recommended to get vaccinated.
This test and the vaccination, if necessary, is covered by health insurance.
Whooping cough
Since a large number of studies have shown that infants born to mothers who received a pertussis (whooping cough) vaccination during their pregnancy are significantly less likely to contract pertussis than infants born to mothers who did not receive vaccination during pregnancy, it is recommended that pregnant women receive a whooping cough vaccination early in their third trimester of pregnancy.
This is because babies are most susceptible to whooping cough in the first two months of their life but cannot be vaccinated against whooping cough themselves until they are two months old.
If you have recently had pertussis or a pertussis shot, check with your doctor if another vaccination is recommended.
A vaccination during pregnancy is considered as safe as a vaccination before the pregnancy as no negative effects on the course of pregnancy or on the newborn have been observed in studies or in the monitoring of vaccination side effects.
The vaccination would be covered by health insurance.
Flu shots
You may be offered a seasonal flu shot by your doctor. This is because pregnant people are more susceptible to developing serious cases or requiring hospitalization when getting the flu during pregnancy due to changes in the immune system during pregnancy. A flu infection can also increase certain risks during pregnancy, including a higher risk for miscarriage, premature birth, and low birth weight
If you’d like to have it, you will be recommended to have the vaccination from the second trimester. If you have an increased health risk due to an underlying condition, you will likely be recommended to get vaccinated in the first trimester.
The vaccination would be covered by health insurance.
Pregnancy diabetes test
In pregnancy month 6 or 7 (week 24-28) you will be offered a glucose test at your OBGYN or midwife practice to check whether you might have pregnancy (or gestational) diabetes. This test is called “Zuckertest” in German. Learn more in our dedicated article "The Pregnancy Diabetes Test in Germany."
Ultrasounds
You will be offered three ultrasounds in the course of your pregnancy: in weeks 9-12, weeks 17-20, and weeks 19-32.
Cardiotocography (CTG)
Cardiotocography is a continuous recording of the fetal heart rate obtained via an ultrasound transducer placed on the pregnant person's abdomen.
It used to be standard practice for appointments after pregnancy week 32 and is still offered by many gynecologists. However, according to the most recent guidelines, CTGs are not recommended for low risk pregnancies up until their estimated due date. After the due date, it is recommended to run a CTG every two days.
For women with a high-risk pregnancy or an abnormal finding during pregnancy, it may make sense to have a CTG earlier and more regularly in pregnancy. It’s best to discuss this with your OBGYN or midwife.
