Prenatal testing

Photo of a young couple and a doctor at a consultation

A number of prenatal examinations are offered during pregnancy to check how a child is developing. The word "prenatal" comes from the Latin words that mean "before birth." There are standard examinations like ultrasound scans, and extra examinations such as the non-invasive prenatal test (NIPT) for trisomy syndromes like Down syndrome.

People who are expecting a child are probably full of anticipation and hope. There's good reason for this because most babies are born healthy.

Regular check-ups are carried out during pregnancy to check whether the baby is developing normally and the mother is healthy. In Germany, certain standard examinations are covered by statutory health insurers. Other, more detailed examinations might be done in certain situations if an abnormality has been found. The costs of some of these examinations are then also covered by statutory health insurers.


All of these examinations are voluntary. Every woman can decide for herself which ones she wants to have.

Illustration: Prenatal testing

Which standard prenatal examinations are covered by statutory health insurers in Germany?

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 .

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.

Which extra examinations are covered?

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

Non-invasive prenatal test: Blood test for trisomy 13, 18 and 21 (Down syndrome)

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.

Amniocentesis and chorionic villus sampling (CVS)

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.

What other kinds of prenatal examinations are there?

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.

First trimester screening

Many doctors offer a “first trimester ” 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 examination, including heart defects, spina bifida, or deformities in the abdominal wall. The is offered between the 12th and 14th week of pregnancy. The first trimester is usually not covered by statutory health insurers in Germany.

Do I have to do prenatal tests?

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).

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Information for health insurance fund members on prenatal testing: Final report. Commission P17-01. Version 1.0. 2020.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on September 21, 2022

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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