Pregnancy

Laboratory tests

• Blood group (father and mother – not reimbursed in France)
• Irregular antibody screen
• Toxoplasmosis serology
• Rubella serology
• HIV serologyif neededTo offer to the woman or the couple when planning a pregnancy.
• Anti-HBs antibodiesif neededWoman vaccinated against hepatitis B, to check immunity and offer a booster if needed (otherwise HBsAg); depending on risk factors.
• HBsAg (unvaccinated woman, depending on risk factors)if neededTo offer according to risk factors (occupational, addictions, history of transfusion), after information on the risk of vertical transmission, in an unvaccinated woman ^[3].
• Hepatitis C serology (depending on risk factors)if neededTo offer according to risk factors (occupational, addictions, history of transfusion) ^[3].
• Syphilis serology (depending on risk factors)if neededTo offer according to risk factors, after information on the risk of vertical transmission ^[3].
• CMV serologyif neededPlanning a pregnancy: HAS (July 2026) recommends a first serology ideally before conception; IgG positive and IgM negative: no test for future pregnancies; negative: repeat serology from the start of pregnancy, before 14 weeks ^[4].
• TSH (if risk factor for thyroid dysfunction)if neededTargeted measurement recommended before conception in case of a risk factor (HAS list in the note of the next tab) ^[5]; see the page "Thyroid and pregnancy".
• Fasting plasma glucose (if risk factor for diabetes)if neededRisk factor for gestational or type 2 diabetes (age ≥ 35 years, BMI ≥ 25 kg/m², diabetes in a 1st-degree relative, history of gestational diabetes or of a macrosomic baby): screening ideally before conception ^[6].
• Haemoglobin electrophoresis (woman and partner from a region with high prevalence of haemoglobinopathy)if neededWomen and men planning parenthood, originating from sub-Saharan Africa, North Africa, the Middle East, the Indian subcontinent, South-East Asia, the intertropical zone of Latin America or the Caribbean ^[7].

Laboratory tests

• Serum β-hCGif neededIf the pregnancy is not yet confirmed, or to date it or follow its course in case of doubt (bleeding, pain, uncertain gestational age).
• Blood group
• Irregular antibody screen (excluding antibodies against A and B antigens)
• Toxoplasmosis serology
• Rubella serology
• Syphilis serology
• HBsAg
• Hepatitis C serologyif neededNeither mandatory (Public Health Code) nor in the HAS follow-up table; the experts' report on hepatitis (2014) proposes combining it with HBV and HIV screening at the 1st prenatal visit ^[8,9,10].
• HIV serologyif neededTo offer systematically to every pregnant woman, after information on the risk of mother-to-child transmission; it remains subject to her consent.
• CMV serologyif neededCMV status negative or unknown: IgG and IgM serology as early as possible, before 14 weeks (HAS, June 2025 and July 2026); on the prescription, state the pregnancy and its start date; the laboratory adds avidity if needed ^[4].

Urine tests on a spot sample: (if dipstick not done during the visit)

• Glycosuria
• Urine protein:creatinine ratio

If risk factors

• FBCif neededScreening for anaemia in case of a risk factor at the 1st visit ^[8]; a blood count is mandatory in the 6th month ^[9].
• TSHif neededRisk factor for thyroid dysfunction (HAS list in the note) ^[5]; see the page "Thyroid and pregnancy".
• Fasting plasma glucoseif neededAt least one risk factor for gestational diabetes (age ≥ 35 years, BMI ≥ 25 kg/m², diabetes in a 1st-degree relative, history of gestational diabetes or of a macrosomic baby): look for unrecognised type 2 diabetes ^[6]; see the page "Gestational diabetes".
• Urine microscopy and culture if history of urinary infections, diabetes or positive urine dipstickif neededHistory of urinary tract infections, diabetes, or positive urine dipstick.
• Haemoglobin electrophoresis (from a region with high prevalence of haemoglobinopathy)if neededPregnant woman originating from sub-Saharan Africa, North Africa, the Middle East, the Indian subcontinent, South-East Asia, the intertropical zone of Latin America or the Caribbean, ideally before 12 weeks ^[7].
• Blood lead (lead exposure identified by the questionnaire)if neededSystematic screening recommended at the 1st visit or at the early prenatal interview; blood lead if at least one answer suggests current or past exposure (old dilapidated housing or housing under renovation, industrial site, occupational or leisure activity, cosmetics or traditional remedies, pica, recent arrival in France, etc.) ^[11].
• Chlamydia trachomatis and Neisseria gonorrhoeae NAAT (PCR), vaginal sample or first-catch urine (if age ≤ 25 years or risk factor for STI)if neededHAS (2018) recommends offering Chlamydia trachomatis screening, at a consultation, to every sexually active woman from 15 to 25 years inclusive, pregnancy included, then targeting it after 25 years in case of a risk factor (at least two partners in the year, recent change of partner, STI in the woman or her partner, history of STI) ^[12]. The United States screens for chlamydia and gonorrhoea in pregnant women aged 24 years or under or at risk (grade B) ^[13], and Germany tests all pregnant women for Chlamydia, by PCR on urine, at the first examination ^[14]. This test is not among the mandatory prenatal tests ^[9]. Depending on practices and exposure, several sites may be sampled (NABM codes 5302 for 2 sites and 5303 for 3 sites) ^[2].

Laboratory tests

• FBC
• Serum electrolytes
• Serum creatinine with GFR
• Fasting plasma glucoseif neededKnown diabetes: look for ketoacidosis ^[28]. The CNGOF does not include it in the routine tests ^[29].
• Urine dipstick / urine microscopy and culture
• TSHif neededHyperemesis refractory to treatment or history of hospitalisation for hyperemesis: look for thyroid dysfunction, liver involvement, calcium disorder and pancreatitis.
• ASTif neededHyperemesis refractory to treatment or history of hospitalisation for hyperemesis: look for thyroid dysfunction, liver involvement, calcium disorder and pancreatitis.
• ALTif neededHyperemesis refractory to treatment or history of hospitalisation for hyperemesis: look for thyroid dysfunction, liver involvement, calcium disorder and pancreatitis.
• GGTif neededHyperemesis refractory to treatment or history of hospitalisation for hyperemesis: look for thyroid dysfunction, liver involvement, calcium disorder and pancreatitis.
• ALPif neededHyperemesis refractory to treatment or history of hospitalisation for hyperemesis: look for thyroid dysfunction, liver involvement, calcium disorder and pancreatitis.
• Serum calciumif neededHyperemesis refractory to treatment or history of hospitalisation for hyperemesis: look for thyroid dysfunction, liver involvement, calcium disorder and pancreatitis.
• Serum albuminif neededHyperemesis refractory to treatment or history of hospitalisation for hyperemesis: look for thyroid dysfunction, liver involvement, calcium disorder and pancreatitis.
• Serum lipaseif neededHyperemesis refractory to treatment or history of hospitalisation for hyperemesis: look for thyroid dysfunction, liver involvement, calcium disorder and pancreatitis.
• CRP (persistence or worsening despite well-conducted treatment)if neededPersistence or worsening of symptoms after well-conducted treatment: work-up of the differential diagnoses (hepatitis, pancreatitis, appendicitis, pyelonephritis, adnexal torsion, hyperthyroidism) ^[29].

Laboratory tests

• Toxoplasmosis serology if not immune
• Rubella serology if not immune (up to 18 weeks of gestation according to HAS 2016; at 20 weeks of gestation according to HAS 2009)
• Serum markers as part of T21 screening (offered at the T1 ultrasound)
• 2nd-trimester serum markers (14 to 17 weeks of gestation + 6 days), if combined screening could not be doneif needed1st-trimester combined screening not possible (deadline passed, nuchal translucency not measurable): serum markers from 14.0 to 17 weeks + 6 days ^[2,8].
• Cell-free circulating DNA for trisomy 21 (risk between 1/1 000 and 1/51)if neededRisk of trisomy 21 between 1/1 000 and 1/51 after serum markers; from 1/50, cell-free DNA test or fetal karyotype straight away, to be discussed with the woman; a positive test is confirmed by fetal karyotype ^[31].
• Fetal RhD genotyping (if mother RhD negative)if neededRhD-negative mother: from 11 weeks; a negative or indeterminate result requires a second determination 15 days later ^[2].
• Follow-up CMV serology (IgG negative: every 4 weeks until 13-14 weeks of gestation)if neededNegative CMV serology in early pregnancy: repeat every 4 weeks, preferably in the same laboratory, the last between 13+0 and 14+0 weeks ^[4].

Urine tests on a urine sample: (if dipstick not done during the visit)

• Glycosuria
• Urine protein:creatinine ratio
• Urine microscopy and culture if history of urinary infections, diabetes or positive urine dipstickif neededHistory of urinary tract infections, diabetes, or positive urine dipstick.

Laboratory tests

• Toxoplasmosis serology if not immune
• Rubella serology if not immune (up to 18 weeks of gestation according to HAS 2016; at 20 weeks of gestation according to HAS 2009)
• Irregular antibody screen in the 9th month (if RhD negative, or history of transfusion)if needed9th month: mandatory test in Rh-negative women or those previously transfused ^[9].

Urine tests: (if dipstick not done during the visit)

• Glycosuria
• Urine protein:creatinine ratio
• Urine microscopy and culture if history of urinary infections, diabetes or positive urine dipstickif neededHistory of urinary tract infections, diabetes, or positive urine dipstick.

Laboratory tests

• Toxoplasmosis serology if not immune
• FBC
• HBsAg (if not done at the start of pregnancy)if neededMandatory test of the 6th month ^[9]; no need to repeat it if it was done at the 1st visit, except in case of high-risk exposure (repeat in the 3rd trimester) ^[18].
• Irregular antibody screen (if RhD negative; or if RhD positive with a history of transfusion)
• 75 g oral glucose tolerance test if risk factor for gestational diabetes*if neededBetween 24 and 28 weeks, in a woman with at least one risk factor and a 1st-trimester fasting plasma glucose < 0.92 g/L ^[6]; see the page "Gestational diabetes".
• Second syphilis test (woman at risk, 3rd trimester, ideally before 28 weeks of gestation)if neededWoman considered at risk: second test in the 3rd trimester, ideally before the 28th week ^[15].

Urine tests: (if dipstick not done during the visit)

• Glycosuria
• Urine protein:creatinine ratio
• Urine microscopy and culture if history of urinary infections, diabetes or positive urine dipstickif neededHistory of urinary tract infections, diabetes, or positive urine dipstick.

Laboratory tests

• Toxoplasmosis serology if not immune
• Blood group (2nd determination if not done previously)
• Irregular antibody screen (if RhD negative; or if RhD positive with a history of transfusion)
• Vaginal swab for group B streptococcus (between 35 and 38 weeks of gestation)

Urine tests: (if dipstick not done during the visit)

• Glycosuria
• Urine protein:creatinine ratio
• Urine microscopy and culture if history of urinary infections, diabetes or positive urine dipstickif neededHistory of urinary tract infections, diabetes, or positive urine dipstick.