The goals of prenatal care for all pregnant refugee women are to provide quality obstetrical care that respects the woman and her family’s traditional health beliefs; supports physical, mental, and emotional health and well-being; and contributes to a safe birth and favorable outcomes for both the mother and child. One objective of Healthy People 2020 is to increase the proportion of pregnant women who receive early and adequate prenatal care to 78%.[1]

For pregnant refugee women, malnutrition may pose a challenge in the early period of resettlement due to insufficient access to food in war-torn environments and refugee camp conditions. Ongoing nutritional support, counseling, and early intervention are critical to promoting healthy food choices and physical activity, which will limit the onset of obesity and avoid diabetes as well as macrosomia (excess fetal weight gain) during pregnancy.

A pelvic examination may need to be deferred, particularly in women who have undergone the most extensive form of female genital cutting (infibulation), where a speculum exam may be extremely painful, if not impossible. In such circumstances, obtaining urinary gonorrhea/chlamydia tests instead of genital swabs is recommended.

Finally, it is important to ask patients about any previous history of perinatal and/or child loss and the cause, if known.

Routine Laboratory Tests for Pregnant Women [2]

  • Blood type, antibody screen, and Rh factor
  • Human Immunodeficiency Virus (HIV)
  • Gonorrhea and Chlamydia cultures (urinary or genital swab)
  • Rapid plasma reagent (RPR)
  • Rubella titer
  • Hepatitis B surface antigen
  • Complete blood count
  • Hemoglobin Electrophoresis (for women of African, Southeast Asian, and Mediterranean ancestry to screen for thalassemia or sickle cell anemia)
  • Urine analysis with culture and sensitivity, if indicated

Additional Screening Recommendations:

  • Domestic violence/intimate partner violence or other forms of gender-based violence
  • Immunization history including verification of vaccines for influenza (seasonal vaccine administration is safe during pregnancy), measles/mumps/rubella (MMR), varicella, and tetanus/diphtheria/pertussis (TDaP). If there is no evidence of vaccination or immunity, provide all of the above mentioned vaccines except MMR and varicella, which are live vaccines and thus should be given postpartum
  • Tuberculosis (TB) skin test or Interferon-Gamma Release Assay (IGRA), as indicated, and screening for symptoms. Any patient suspected of having TB disease should receive a complete evaluation that includes medical history, physical examination, and chest x-ray.[3]
  • Malaria screening if patient recently emigrated from malaria-endemic region and displays clinical signs and symptoms (i.e. unexplained fever)
  • Substance use including exposure to tobacco, alcohol, and illicit drugs. Also check for exposure to herbal and other traditional/alternative medications or substances

CDC TB Resources:

Other Pregnancy Topics:

[1] U.S. Department of Health and Human Services. Maternal, Infant and Child Health. Objectives for Improving Health. Healthy People 2020.

[2] American College of Obstetricians and Gynecologists.  Frequently Asked Questions: Routine Tests in Pregnancy. 2011.

[3] U.S. Centers for Disease Control and Prevention.  Factsheet: Diagnosis of Tuberculosis Disease.  2011.