First Prenatal Visit
(regardless of gestational age)
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- HIV-1,2 antigen/antibody (Ag/Ab) combination Immunoassay2, 5
- Syphilis5 serology6
- Chlamydia (CT)7
- Gonorrhea (GC)7
- Hepatitis B virus (HBV) surface antigen (HBsAg), HBV core antibody (anti-HBc), and HBV surface antibody (anti-HBs)8
- Hepatitis C virus (HCV) antibody (anti-HCV) with reflex HCV RNA viral load if anti-HCV positive10
- Type-specific Herpes Simplex Virus (HSV) serology NOT routinely recommended11
- Cervical cancer screening if age ≥21 years and indicated by national guidelines12
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Third Trimester
(assuming first prenatal visit has already occurred; if not, see screening recommendations above)
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- HIV if high risk2, 3, 5
- Syphilis5 serology6 at approximately 28 weeks' gestation or as soon as possible thereafter
- CT and GC if age <25 years, positive test earlier in pregnancy, or if at an increased risk7
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During Labor & Delivery
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- Expedited HIV testing (results within one hour) if HIV status undocumented or if not re-tested in third trimester but remain at increased risk for HIV3, 4
- Syphilis5 serology6 on all pregnant people at delivery
- HBsAg, HBV core antibody (anti-HBc), and HBV surface antibody (anti-HBs) on admission if no documentation of prior screening or if at increased risk8, 9
- Hepatitis C virus (HCV) antibody (anti-HCV) with reflex HCV RNA viral load if anti-HCV positive on admission if no documentation of prior screening10
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Recommended vaccinations during pregnancy: COVID-19, influenza, Tdap (between 27th and 36th weeks of each pregnancy), and RSV (between 32nd and 36th weeks of pregnancy during September-January). HBV vaccine may also be given during pregnancy to people who are susceptible and at increased risk of Hepatitis B infection. See Guidelines for Vaccinating Pregnant Persons | Pregnancy & Vaccines | CDC.
1 Local health jurisdictions may have additional screening recommendations during pregnancy (e.g., HIV screening2). Clinicians should screen according to their local guidelines.
HIV
2 All pregnant people should be tested with an HIV-1,2 antigen/antibody (Ag/Ab) combination immunoassay as early as possible in each pregnancy. Additionally, partners of pregnant people should be referred for HIV testing if their HIV status is unknown. A reactive HIV Ag/Ab test result should be followed by supplemental testing to differentiate between HIV-1 and HIV-2 antibodies. If supplemental testing for HIV-1/HIV-2 antibodies is nonreactive or indeterminate, or if an acute HIV infection or recent HIV exposure is suspected or reported, then an HIV-1 nucleic acid test (NAT; e.g., HIV RNA) is recommended to differentiate acute HIV-1 infection from a false-positive screening HIV test result. For any reactive HIV screening test late in pregnancy or during labor, consider concurrent HIV-1 NAT (e.g., HIV RNA assay) and HIV-1/HIV-2 antibody differentiation assay.
3 Risk factors for acquiring HIV: injection drug use; sex partner of a person who injects drugs; exchanging sex for money or drugs (transactional sex); sex partner of a person with HIV; new sex partner or more than one sex partner during the current pregnancy; suspected or diagnosed STI during pregnancy (e.g., syphilis); signs and/or symptoms of acute HIV infection or exposure to HIV; or those receiving care in facilities with an HIV incidence rate of >1 case per 1000 pregnant persons per year or residing in a local health jurisdiction with high HIV incidence rates. See Maternal HIV Testing and Identification of Perinatal HIV Exposure | NIH.
4 Expedited HIV testing is defined as testing with a very short turnaround time for results (e.g., one hour). Although HIV-1,2 Ag/Ab combination immunoassays are the recommended test for HIV screening in clinical settings, expedited testing is dependent on the available HIV tests in a particular facility and may include antigen/antibody combination immunoassays, antibody-only assays, or HIV nucleic acid tests (e.g., HIV RNA).
If the pregnant person has a positive HIV test result during labor and delivery, or postpartum, or when a newborn's expedited antibody test is positive, supplemental HIV testing should be performed on the mother (e.g., an HIV-1/HIV-2 antibody differentiation assay and in most cases an HIV RNA assay) and the infant (HIV RNA assay).
5 Confirm HIV and syphilis status of all pregnant persons receiving care or services at emergency departments; urgent care clinics; jails; mental health, drug treatment, and syringe services programs; and street medicine or homeless outreach programs with documented lab results or by providing opt-out HIV and syphilis testing. See Dear Colleague Letter: Call to Expand HIV and Syphilis Testing for Pregnant Women (11/2021) (PDF) and also California Department of Public Health (CDPH) Updates Syphilis Screening Recommendations (10/2024).
Syphilis
6 Screening for syphilis is based on serologic tests for the detection of treponemal and nontreponemal antibodies using either the traditional or reverse algorithm. See California Department of Public Health (CDPH) Updates Syphilis Screening Recommendations (10/2024), American College of Obstetricians and Gynecologists (ACOG) Syphilis Screening Algorithm (10/2024) (PDF), and the California Prevention Training Center (CAPTC) Clinical Interpretation of Syphilis Screening Algorithms (6/2024).
Gonorrhea (GC)/Chlamydia (CT)
7 CDPH recommends universal GC/CT screening in the first trimester based on the high prevalence of GC/CT among Californians who could become pregnant. The U.S. Centers for Disease Control and Prevention (CDC) recommends screening for GC/CT in the first trimester if age <25 or at increased risk. Both CDC and CDPH recommend screening for GC/CT in the third trimester if age <25 or at increased risk. Risk factors for CT or GC include prior CT or GC infection (particularly in past 24 months); new or multiple partners; suspicion a recent partner may have had concurrent partners; sex partner diagnosed with an STI; exchanging sex for money or drugs; illicit drug use; history of incarceration; and/or community prevalence of infection.
Hepatitis B & C
8 Hepatitis B virus (HBV) screening is recommended for all pregnant persons during each pregnancy. CDC guidance (2023) recommends screening all adults (including pregnant persons) at least once with a triple panel of HBsAg, anti-HBs, and anti-HBc. Prior guidance recommended screening of pregnant persons with HBsAg alone. Based on new guidance, pregnant persons with a history of appropriately timed triple panel screening and without subsequent risk for exposure to HBV (i.e., no new HBV exposures since triple panel screening) only need HBsAg screening. United States Preventative Services Task Force (USPSTF) and California law (AB 789, PDF) continue to recommend risk-based screening of adults. USPSTF recommends use of HBsAg as the initial screening test for pregnant persons. See Clinical Testing and Diagnosis for Hepatitis B.
9 Risk factors for hepatitis B: injection drug use; new STI diagnosis in pregnancy; new or multiple partners; or HBsAg-positive partner.
10 Hepatitis C virus (HCV) screening is recommended for all pregnant persons - and during each pregnancy. To test for HCV, order an HCV antibody (anti-HCV) test with automatic reflex HCV RNA viral load for specimens testing anti-HCV positive/reactive. For persons who are immunocompromised, testing for HCV RNA can be considered. For persons who might have been exposed to HCV within the past six months, testing for HCV RNA two weeks after exposure or testing for anti-HCV six months after exposure is recommended. If, after implementing routine HCV screening for all pregnant persons, a health care facility consistently finds <0.1% HCV RNA positivity, the facility may reevaluate the costs and benefits of routine HCV screening in pregnancy. For persons who are immunocompromised, testing for HCV RNA can be considered. See CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020 | MMWR.
Herpes Simplex Virus – 2 (HSV-2)
11 Routine HSV-2 serologic screening of pregnant people is not recommended. HSV-2 serologic tests are useful for pregnant persons at risk for HSV infection (e.g., sex partner with HSV).
12 Cervical Cancer Screening Guidelines (5/2021).