There are many tests that are recommended for pregnant persons in Germany, many of which are covered by German health insurance. You can learn about these in our article “Recommended Tests & Vaccinations in Pregnancy in Germany”.
However, there are also a few tests that may be offered to you, which are not covered by public health insurance.
We asked midwife Amelie Suermann what these tests are and how you can decide whether you’d like to pay for them privately.
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!
Toxoplasmosis
Toxoplasmosis (Toxoplasmose in German) is caused by the parasite Toxoplasma gondii. It can be found in raw meat, cat feces, soil and sometimes also on unwashed fruits and vegetables.
If a pregnant person is infected with toxoplasmosis for the first time during their pregnancy, it can be passed on to the unborn child and lead to complications.
According to figures from the Robert Koch Institute from the year 2000, the infection is passed on to the unborn child in about 15 percent of cases during the first trimester, about 24 percent during the second trimester and about 64 percent during the third trimester. However, the severity of the damage is reversed: If the infection is passed on to the child in early pregnancy, the damage is usually more severe or it can lead to a miscarriage.
The toxoplasmosis test, which may be offered to you early on in your pregnancy can check for antibodies against the disease. However, not all public health insurance companies pay for the test, unless there is a reasonable suspicion of infection with toxoplasmosis. If you would like for the test to be done at your OBGYN’s office, you would pay privately (between €14 and €16).
If you have the test done by your midwife, it will be free of charge.
However, the initial test may not be enough: if antibodies are detected, further tests must be performed to determine when the infection took place. The follow-on tests are usually paid for by the health insurance companies, since there is a suspicion of infection.
If no antibodies are detected in the pregnant person's blood, the test must be repeated every eight weeks in order to detect a new infection. In this case, you will most likely have to pay for the tests yourself. If you are not immune (ie you don’t have antibodies), it is recommended that you avoid the above mentioned potential sources of infection. This includes wearing gloves and thoroughly washing your hands when working with soil, avoiding contact with cat feces and washing fruit and vegetables well before eating them.
Cytomegaly (CMV)
Another test that may be offered to you early on in your pregnancy is for cytomegaly (Cytomegalie in German). This is a herpes virus that is transmitted via body fluids such as saliva, blood or urine. This test is especially relevant for pregnant people who already have children or work with children, such as teachers or Kita educators.
If a pregnant person is infected with cytomegaly for the first time during their pregnancy, it could pass over to the unborn child. During the first trimester, this is the case in about 20% of the initial infections, according to the Robert-Koch-Institut. If the unborn child is infected in the first trimester, it can lead to serious complications in about 50% of cases.
After about week 20 of pregnancy, an infection with cytomegaly is unlikely to harm the unborn child.
If you want to take the test at your OBGYN office, it is not covered by most public health insurance companies and you should expect to pay around €30 for it. Some public health insurance companies may cover it partially.
If you have it done by your midwife, it will be free of charge.
If the test comes back negative, it is recommended that you repeat it around pregnancy weeks 12 to 14. It is also recommended that you take appropriate measures to avoid becoming infected: Thorough hand washing with soap is important, especially after contact with saliva or after changing an infant’s diapers.
If the pregnant person's blood shows sufficient antibodies in the CMV test, the initial infection can no longer affect her.
B Streptococcus (GBS)
Group B streptococcus (GBS) are a bacteria that may naturally occur in the intestinal flora. They usually settle in the anal area and can migrate to the vagina and urinary tract. In German, they are called Gruppe-B-Streptokokken.
It is estimated that about 18% of pregnant people are carriers of GBS. There are no symptoms in most people that carry GBS and usually no illness is caused by it in people with healthy immune systems.
However, if GBS is transmitted to the infant during birth, there is a 1-2% chance that the baby may develop GBS disease. This is a serious infection that usually requires the baby to be hospitalized in the NICU and be treated with antibiotics.
To avoid the colonization of the baby with GBS and to lower the risk of GBS disease, it is recommended that pregnant GBS carriers are treated with antibiotics during labor. If the birthing person with GBS is treated with antibiotics during labor at least 4 hours before birth, the baby’s odds of developing GBS disease drop from 1% to about 0.2%.
Therefore, you may be offered a test between the 35th and 37th week of pregnancy to screen for GBS. This is done by a gynecologist or midwife who takes a swab from the vaginal and anal areas.
If you test positive for GBS, it will be noted in your Mutterpass and the recommended place of birth would be a hospital. Current guidelines recommend administering IV antibiotics during labor as a prophylaxis for GBS disease for GBS carriers, starting with the onset of regular contractions or after your water breaks. If you decide against testing for GBS, you are usually only offered antibiotics after your waters have broken for an extended period of time or if you develop signs of infection.
Testing for GBS is not mandatory. On the one hand, opting out of testing may avoid the unnecessary use of antibiotics during labor as the baby’s risk of developing GBS disease is only 1-2% in a positive result.
On the other hand, testing and the administration of antibiotics have proven to significantly reduce the risk for GBS disease in infants and GBS disease remains one of the main causes of severe infections in the newborn period. With this information in mind, you can discuss the topic with your care provider and make an informed decision.
If there is a suspicion of a possible B streptococcus infection, every insurance company will cover the costs of the test. Otherwise, you will pay for this privately (approx. €30-50).
Parvovirus B19
Parvovirus B19 (Ringelröteln in German) is a disease that usually presents itself with mild flu symptoms and a rash. It is most common in young children. About 50% of adults will have immunity for Parvovirus B19 from a previous infection. A test for Parvovirus B19 antibodies is strongly recommended in pregnant people who already have children or work with children, such as teachers or Kita educators.
An infection during pregnancy can cause pregnancy complications including miscarriage and stillbirth, as well as complications for the fetus such as anemia. However, in many cases, an infection during pregnancy will not harm the fetus.
The screening test for antibodies against Parvovirus B19 is not covered by public health insurance unless it is covered in your occupational health check (if you work as a teacher or educator, for example) or if there is a known case of Parvovirus B19 in your family or workplace. If paying privately, the test should cost you around €15-30.
If an acute infection with parvovirus B19 is diagnosed, regular checks are carried out using ultrasound and Doppler ultrasound. If there are indications of anemia in the unborn child, the child can receive a blood transfusion directly in the womb (intrauterine) in a specialized prenatal center.
Additional source: Frauenärzte im Netz: Ringelröteln in der Schwangerschaft
