Screening and Testing for HIV, Viral Hepatitis, STD & Tuberculosis in Pregnancy

At a glance

Screening leads to access to treatment and care that can prevent perinatal transmission. Preconception (before pregnancy) and prenatal care are important opportunities for addressing conditions that can have long-term health impacts.

A pregnant woman receives a medical screening in a doctor's office.

Recommended for all women during pregnancy

CDC recommends that all pregnant women get tested for HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis during each pregnancy. Screening is necessary to access medical services for HCV infection and treatment to prevent transmission of HIV, HBV, and syphilis to the infant. However, early screening opportunities are often missed, and women who receive late or no prenatal care are less likely to be screened and treated for HIV, HBV, and syphilis.12

Current screening statistics‎

Approximately 75%–80% of pregnant women are screened for HIV infection34

Approximately 84%–88% of pregnant women are screened for HBV infection5

Approximately 85% of commercially insured pregnant women are screened for syphilis4

Approximately 41% of pregnant women are screened for HCV infection6*

*percentage reflects testing approximately one year after publication of the 2020 recommendation that all pregnant women be screened for hepatitis C during each pregnancy

Clinician timeline

Recommended clinician timeline for screening for syphilis, HIV, HBV, HCV, chlamydia, and gonorrhea

All persons diagnosed with an infection should be treated or linked to care and treatment as recommended.

First prenatal visit

Syphilis: All pregnant women

HIV: All pregnant womenA

HBV: All pregnant womenB

Chlamydia: All pregnant women less than 25 years of age and older pregnant women at increased riskC

Gonorrhea: All pregnant women less than 25 years of age and older pregnant women at increased riskC

HCV: All pregnant womenD

Third trimester

Syphilis: Certain groups of pregnant womenE at 28 weeks at risk for infection or reinfection this pregnancy

HIV: Certain groups of pregnant womenF before 36 weeks

Chlamydia: Pregnant women less than 25 years of age or continued high riskC

Gonorrhea: Pregnant women with ongoing risk factorsC

HCV: Pregnant women with ongoing risk factorsD

At delivery

Syphilis: Certain groups of pregnant women at risk for infection or reinfection this pregnancyE, pregnant women with no previously established syphilis screening this pregnancy, and all pregnant women who deliver a stillborn infant

HIV: Pregnant women not screened during pregnancy

HBV: Pregnant women not screened during pregnancyG, who are at high riskH, or with signs or symptoms of hepatitis

HCV: Pregnant women not previously screened

United States preventive services task force grade recommendations guide insurance coverage for services.‎

The most recent USPSTF grade recommendations for testing is "A" for Syphilis, HIV, and HBV, and "B" for HCV. For more information, see Preventive Services Coverage.

Targeted testing for TB

Targeted testing and treatment of women at high risk for tuberculosis

Testing and treatment for LTBI of asymptomatic women during pregnancy should be pursued only in the context of known risk factors for exposure to TB (such as residence in a homeless shelter or birth or residence in a high TB prevalence country) or for progression to TB disease (such as diabetes or HIV). The TB skin test and interferon gamma release assays (IGRAs) are safe in pregnancy.

LTBI treatment should be delayed until three or more months after delivery, when possible, to minimize the risk of hepatitis, but treatment during pregnancy may be indicated for contacts and those at highest risk for progression to TB disease (i.e., those with HIV infection or recent M. tuberculosis infection). Providers should closely monitor those receiving LTBI treatment for adverse events and to ensure adherence.

Women with signs or symptoms of TB disease or a positive test for TB infection should be further evaluated for TB disease.

TB disease is associated with adverse maternal and fetal outcomes, and should always be promptly treated, even in pregnant women. These evaluations should include: a clinical history and physical examination, a chest radiograph (with shielding to protect the fetus), and sputum smear microscopy, culture, and nucleic acid amplification testing (if indicated based on history or radiographic findings).

Pyridoxine should be given to pregnant or breastfeeding women who are prescribed isoniazid.

Risk factors for exposure to TB disease

  • Close contact with persons known or suspected to have TB
  • Having been born or lived in high TB prevalence countries
  • Living or working in congregate settings, such as correctional institutions, homeless facilities, or healthcare facilities

Risk of progressing to TB disease once infected

Medical risk factors known to increase risk of disease in the context of infection:

  • HIV infection
  • Potent immunosuppressive therapy (e.g. immunosuppressive drugs such as prednisone or TNF-a antagonists)
  • Diabetes
  • Cancer
  • Substance use
  1. To promote informed and timely therapeutic decisions, health care providers should test women for HIV as early as possible during each pregnancy.
  2. All pregnant women should be tested for hepatitis B surface antigen (HBsAg) during an early prenatal visit (e.g., first trimester) in each pregnancy, even if they have been vaccinated or tested previously.
  3. “Increased risk” means new or multiple sex partners, sex partner with concurrent partners, or a sex partner who had a sexually transmitted infection (STI).
  4. All pregnant women should be tested for hepatitis C during each pregnancy, except in settings where the prevalence of HCV infection is less than 0.1%. Data informing the optimal time during pregnancy for which hepatitis C testing should occur are lacking. Testing at an early prenatal visit harmonizes testing for hepatitis C with testing for other infectious diseases during pregnancy. Pregnant women with ongoing risk factors (e.g., injection-drug use) tested early in pregnancy could undergo repeat testing later in pregnancy to identify those who acquired HCV infection later in pregnancy.
  5. “Certain groups” includes people who live in communities with high rates of syphilis or are at high risk for syphilis acquisition during pregnancy. Maternal risk factors for syphilis during pregnancy include sex with multiple partners, sex in conjunction with drug use or transactional sex, late entry to prenatal care (i.e., first visit during the second trimester or later) or no prenatal care, methamphetamine or heroin use, incarceration of the woman or her partner, and unstable housing or homelessness.
  6. “Certain groups” includes people who receive health care in areas with an elevated incidence of HIV or AIDS among females aged 15-45 years, who receive health care in facilities in which prenatal screening identifies at least one HIV diagnosis per 1,000 females screened, known to be at high risk for HIV (i.e., person who injects drugs and their sex partners, person who exchanges sex for money or drugs, sex partner of person living with HIV, have had a new or >1 sex partner during this pregnancy), or have signs or symptoms consistent with acute HIV infection.
  7. People admitted for delivery at a health care facility without documentation of HBsAg test results should have blood drawn and tested as soon as possible after admission.
  8. Having had more than one sex partner during the previous 6 months, an HBsAg-positive sex partner, evaluation or treatment for an STD, or injection-drug use.
  1. Koumans EHA, Rosen J, van Dyke MK, et al. Prevention of mother-to-child transmission of infections during pregnancy: implementation of recommended interventions, United States, 2003-2004. Am J Obstet Gynecol 2012;206(2):158.
  2. Momplaisir FM, Brady KA, Fekete, et al. Time of HIV diagnosis and engagement in prenatal care impact virologic outcomes of pregnant women with HIV. PLoS One 2015;10(7):1-12.
  3. Fitz Harris LF, Taylor AW, Zhang F, et al. Factors associated with Human Immunodeficiency Virus screening of women during pregnancy, labor and delivery, United States, 2005-2006. Matern Child Health J 2014;18(3):648–56.
  4. Fanfair RN, Tao G, Owusu-Edusei K, et al. Suboptimal prenatal syphilis testing among commercially insured women in the United States, 2013. Sex Transm Dis 2017; 44(4):219–221.
  5. Kolasa M, Tsai Y, Xu J, Fenlon N, Schillie S. Hepatitis B surface antigen testing among pregnant women, United States 2014. Pediatr Infect Dis J 2016; 36(7):e175-e180.
  6. Kaufman, et al. Hepatitis C Virus Testing During Pregnancy After Universal Screening Recommendations. Obstet Gynecol. 2022. doi: 10.1097/AOG.0000000000004822