Disclosing Pregnancy at the Exam

Pregnant applicants should disclose their pregnancy at the immigration medical exam. This is important because pregnancy affects vaccine recommendations and chest X-ray protocols. The civil surgeon needs to know about the pregnancy to complete the exam safely and accurately.

Attorneys should advise pregnant clients to inform the civil surgeon's office when scheduling the appointment and to confirm the pregnancy at the start of the exam. This allows the civil surgeon to plan the exam appropriately.

Vaccine Considerations During Pregnancy

Some ACIP-required vaccines are contraindicated during pregnancy. Live vaccines — including MMR and varicella — are contraindicated during pregnancy because of the theoretical risk of fetal infection. Pregnant applicants who have not received these vaccines will need to defer them until after delivery.

Other vaccines are recommended during pregnancy. The influenza vaccine (inactivated) is recommended during pregnancy. Tdap is recommended during each pregnancy. COVID-19 vaccines are recommended for pregnant individuals.

The civil surgeon will document which vaccines were administered, which were deferred due to pregnancy, and which are pending post-delivery. Form I-693 may be completed with a notation that certain vaccines are deferred pending delivery. The applicant will need to return after delivery to complete the deferred vaccines.

Chest X-Ray During Pregnancy

Chest X-rays are required when TB testing (TST or IGRA) is positive. If a pregnant applicant has a positive TB test, the civil surgeon must balance the need for a chest X-ray against the risk of radiation exposure to the fetus.

USCIS Technical Instructions allow the civil surgeon to defer the chest X-ray until after delivery if the applicant is pregnant and the clinical situation permits. The civil surgeon will use clinical judgment to determine whether deferral is appropriate. If the applicant has symptoms of active TB, the chest X-ray may be necessary regardless of pregnancy.

If a chest X-ray is performed during pregnancy, abdominal shielding is used to minimize fetal radiation exposure.

Timing the Exam During Pregnancy

There is no prohibition on completing the immigration medical exam during pregnancy. However, attorneys should consider the timing carefully. If the exam is completed early in the pregnancy and some vaccines are deferred, the applicant will need to return after delivery to complete the deferred vaccines — which adds time and cost.

For applicants who are early in their pregnancy and whose case timeline permits, it may be more efficient to schedule the exam after delivery so that all vaccines can be administered at once. Attorneys should discuss the timing with the client and consider the overall case timeline.

Post-Delivery Vaccine Completion

Applicants who deferred vaccines during pregnancy must complete the deferred vaccines after delivery. The civil surgeon will need to update Form I-693 to reflect the completion of the deferred vaccines. Attorneys should advise clients to schedule a follow-up appointment with the civil surgeon promptly after delivery.

USCIS will not adjudicate the adjustment of status application until Form I-693 is complete, including all required vaccines. Delays in completing deferred vaccines can delay the overall case timeline.

Pregnancy and Inadmissibility

Pregnancy itself is not a ground of inadmissibility. The civil surgeon's evaluation focuses on communicable diseases, mental health, and vaccination status — not on the applicant's reproductive status. Attorneys should reassure pregnant clients that the exam is a routine medical evaluation and that pregnancy does not affect their admissibility.