Prenatal testing

All pregnant women can have a check-up with their gynecologist or midwife every four weeks. In the last two months of pregnancy, these check-ups are offered every two weeks. The standard examinations include physical examinations like feeling the tummy and regularly taking blood. The blood can be tested to find out things like your blood group and rhesus factor, and whether there are any signs of infection.

Gynecologists offer an ultrasound scan during a check-up around the 10th, 20th and 30th weeks of pregnancy. They then look at things like how the unborn baby is growing and how its organs are developing. The ultrasound also shows the position of the baby and the placenta.

Further ultrasound examinations may be done if any abnormalities are found. Deformities might also be discovered during the ultrasound scan.

The results of the standard examinations are noted in your maternity records.

Statutory health insurance providers also cover the costs of the following prenatal examinations in certain situations:

The non-invasive prenatal test (NIPT) is a genetic test that examines the baby’s DNA that is shed by the placenta. This DNA is found in the mother's bloodstream. It is called “non-invasive” because doctors don't need to access the womb to get the sample.

Instead, blood is taken from a vein in the mother’s arm. From around the 10th week of pregnancy onwards, her blood contains enough of the unborn baby’s DNA for it to be examined in a laboratory.

If the unborn baby does not have one of these trisomy syndromes, the NIPT test will show that with great certainty. If the test results suggest that the baby may have a trisomy syndrome, another procedure (like an amniotic fluid examination – called amniocentesis) will have to be done to find out for sure. The NIPT test for trisomy syndromes is offered from the 10th week of pregnancy.

In Germany, statutory health insurers now cover the costs of this test (since July 2022) – but only if a woman has decided together with her doctor that it makes sense to do the test in her personal situation. Doctors have to provide detailed information and advice before an NIPT test can be done.

Some medical conditions (including trisomy syndromes) can only be diagnosed for sure by carrying out a procedure. This involves inserting a thin needle through the wall of the belly into the womb, to take either a sample of amniotic fluid from inside the womb (amniocentesis) or a sample of tissue from the placenta (chorionic villus sampling). The procedures lead to a miscarriage in about 1 to 4 out of 1,000 cases.

The costs of these examinations are only covered by statutory health insurers if there’s reason to believe that the unborn baby has certain diseases, deformities or disabilities.

The doctor might offer to do other examinations too, like extra ultrasound scans and blood tests. These are considered to be "individual health care services" (“IGeL”) in Germany, which you have to pay for yourself.

Many doctors offer a “first trimester screening” prenatal test, which can spot signs of various abnormalities. It involves doing an ultrasound scan and taking blood from the mother’s arm. The combination of results allows doctors to calculate the likelihood of certain trisomies, like Down syndrome (trisomy 21). Some doctors also look for other abnormalities during the first trimester screening examination, including heart defects, spina bifida, or deformities in the abdominal wall. The screening is offered between the 12th and 14th week of pregnancy. The first trimester screening is usually not covered by statutory health insurers in Germany.

No. All prenatal testing is voluntary. That means you can turn down any examination that is offered at any time without giving a reason. The right to not know is so important that nobody can force you to have any of the examinations.

Prenatal testing can have far-reaching consequences. It can be helpful, but it can also be unsettling. Before deciding whether to have one of the examinations, it's important to think about how much you would like to know, and what an abnormal finding would mean for you.

Women and couples can get information and advice about prenatal testing at a doctor's office or centers for gynecology, prenatal diagnostics or human genetics. Psychosocial counseling can also be helpful. In Germany, this is mainly offered for free by pregnancy advice centers (Schwangerschaftsberatungsstellen) and can be anonymous if you prefer. You can search for local pregnancy advice centers on the website of the German Federal Centre for Health Education (BZgA).