TB Testing Is Required for All Immigration Applicants

Tuberculosis (TB) screening is a required component of the immigration medical exam for all applicants age 2 and older. The civil surgeon must evaluate every applicant for TB regardless of pregnancy status. Pregnancy does not exempt you from TB testing and does not change the required testing methods.

The two approved TB testing methods for the immigration medical exam are the tuberculin skin test (TST, also called the Mantoux test) and the interferon-gamma release assay (IGRA) blood test. Both are safe and accurate during pregnancy.

Does Pregnancy Affect TST or IGRA Accuracy?

Current medical evidence does not support the idea that pregnancy significantly affects the accuracy of either the TST or the IGRA. Both tests measure the immune system's response to TB antigens, and pregnancy does not fundamentally alter this response in a way that would produce false results.

Some older studies suggested that pregnancy might slightly suppress TST reactivity, but this has not been confirmed in more recent research and is not reflected in current USCIS or CDC guidelines. The civil surgeon will interpret your results using the standard criteria regardless of pregnancy.

What Happens If Your TB Test Is Positive During Pregnancy

If your TST or IGRA is positive, the standard next step is a chest X-ray to evaluate for active TB disease. However, chest X-rays are generally deferred during pregnancy unless there is a clinical indication that makes immediate evaluation necessary.

If you have symptoms suggestive of active TB — such as persistent cough, fever, night sweats, or unexplained weight loss — the civil surgeon may determine that a chest X-ray is medically necessary despite the pregnancy. In that case, abdominal shielding will be used to minimize fetal radiation exposure.

If you have a positive TB test but no symptoms of active TB, the civil surgeon will typically defer the chest X-ray until after delivery and document this on Form I-693. You will need to return after delivery to complete the chest X-ray component.

Latent TB Infection and Pregnancy

A positive TB test without evidence of active disease indicates latent TB infection (LTBI). LTBI is not contagious and does not cause symptoms. Treatment for LTBI is generally deferred during pregnancy because the medications used (isoniazid, rifampin) carry potential risks during pregnancy, and the risk of LTBI progressing to active disease is low in most cases.

Your treating physician — typically an infectious disease specialist or public health provider — will advise on the appropriate timing for LTBI treatment after delivery. The civil surgeon will document the LTBI finding and the deferred treatment plan on Form I-693.

Completing the TB Evaluation After Delivery

If your chest X-ray was deferred during pregnancy due to a positive TB test, you will need to return to the civil surgeon after delivery to complete this component. The civil surgeon will perform or order the chest X-ray, review the results, and update Form I-693 accordingly. Make sure to schedule this follow-up promptly after delivery to avoid delays in your immigration application.