Is It Safe to Have the Exam During Pregnancy?

For most pregnant applicants, the immigration medical exam is safe to undergo. The physical examination, blood draw for syphilis testing, and tuberculosis skin test (TST) or IGRA blood test are all safe during pregnancy. The civil surgeon will take your pregnancy into account when evaluating your health history and making clinical decisions.

The two components that are routinely modified during pregnancy are live vaccines and chest X-rays. These modifications are based on standard medical guidelines and USCIS civil surgeon instructions.

Which Vaccines Are Deferred During Pregnancy?

Live attenuated vaccines are contraindicated during pregnancy due to the theoretical risk of fetal infection. The vaccines deferred during pregnancy include: MMR (measles, mumps, rubella), varicella (chickenpox), and the live attenuated influenza vaccine (nasal spray form). These vaccines will be documented as deferred on Form I-693 with pregnancy listed as the reason.

Inactivated vaccines — including Td/Tdap, inactivated influenza, hepatitis A, hepatitis B, meningococcal, and pneumococcal vaccines — are generally safe during pregnancy and are administered on the standard schedule unless there is another contraindication.

After delivery, the deferred live vaccines must be administered before Form I-693 can be considered complete for those vaccine requirements. The civil surgeon will note the expected follow-up timing.

What About the Chest X-Ray?

Chest X-rays are generally deferred during pregnancy unless there is a clinical indication that makes TB evaluation necessary. If your TB skin test or IGRA is positive, or if you have symptoms suggestive of active TB, the civil surgeon may determine that a chest X-ray is medically necessary despite the pregnancy.

When a chest X-ray is performed during pregnancy, abdominal shielding is used to minimize fetal radiation exposure. The radiation dose from a standard chest X-ray is very low, and the risk to the fetus is considered minimal when shielding is used.

If the chest X-ray is deferred, the civil surgeon will document this on Form I-693 and note that the deferral is due to pregnancy. A follow-up appointment after delivery will be needed to complete the chest X-ray component.

How Does Pregnancy Affect Form I-693?

The civil surgeon will document your pregnancy on Form I-693 and note which components were deferred and why. USCIS understands that pregnancy-related deferrals are standard medical practice and does not penalize applicants for having incomplete components due to pregnancy.

However, the deferred components must be completed after delivery before USCIS will consider Form I-693 fully complete. This means you will need a follow-up appointment with the civil surgeon after you deliver to complete the deferred vaccinations and, if applicable, the chest X-ray.

Timing Considerations

If your green card interview is approaching and you are pregnant, discuss the timing with your immigration attorney. In some cases, it may be possible to submit Form I-693 with the pregnancy-related deferrals noted and complete the remaining components after delivery. In other cases, it may be preferable to wait until after delivery to begin the exam. The right approach depends on your specific immigration timeline.