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USCIS Extends Waiver of 60-Day Rule for Medical Examination Form I-693. Learn More

Immigration Medical Exam Considerations for Pregnant Women

Sep 29, 2022

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Immigration Medical Exam Considerations for Pregnant Women

If you are pregnant, there are special considerations regarding vaccinations and tuberculosis (TB) clearance for the Green Card application.

What Vaccinations Are Required?

Without records, the USCIS considers all applicants, pregnant or not, to be completely unvaccinated, regardless of their countries of origin or memories of having had vaccinations or related diseases in the past. In the absence of records, the following vaccinations are required in pregnant applicants: Tdap (tetanus, diphtheria, and pertussis, aka whooping cough).

  • You should discuss the timing of this vaccination with your obstetrician.
  • It is routinely given during the 27th - 30th week of pregnancy.
  • Your paperwork can be held until you reach your 27th week, which may cause a significant delay in processing your medical paperwork.
  • If you have proof of a Tdap from the past, it must meet the following criteria in order to be valid:
    • It must have been given in the past 10 years
    • You must provide proof of at least two other (three total) tetanus shots with the diphtheria component. Note- This special rule applies to immigrants, not the US-born population.

Hepatitis B

  • While considered to be “safe” at any time during pregnancy, you should consult your obstetrician regarding the timing of this vaccination.
  • If you are certain that you have had the Hepatitis B series of three shots in the past, or if you are a survivor of the disease, you can attempt to “test out” this requirement by obtaining a viral immunity test called a “titer.” The Civil Surgeon must order all titers.

Influenza (flu) vaccination

  • Required only during flu season (October 1 - March 31)
  • Universally recommended for pregnant women.
  • You should consult your obstetrician concerning the timing of this important vaccination.

COVID-19 complete series

  • At least 2 shots of Pfizer or Moderna OR
  • At least 1 shot of Janssen (Johnson & Johnson) OR
  • Any combination of the above OR
  • Any vaccination regimen recognized by the World Health Organization (WHO).
  • Booster shots are not required at this time.
  • As always, you should discuss the timing with your obstetrician.

Also read: Tuberculosis (TB) Vaccination for Immigration Medical Exam

The MMR (measles, mumps, & rubella, aka German measles) vaccination is contraindicated during pregnancy. The following options are available.

Varicella (Chickenpox) vaccination is also contraindicated during pregnancy.

  • If you are certain you have had the MMR or all three diseases in the past, you can attempt to “test out” this requirement by obtaining viral immunity tests called “titers.” The Civil Surgeon must order all titers.
    • If you test negative (no immunity) to any of the three viruses, you should sequester yourself for the remainder of your pregnancy.
      • You will receive an automatic waiver of the MMR requirement for the duration of your pregnancy.
      • You will be expected to obtain an MMR vaccination after your baby and before leaving the hospital--USCIS often confirms compliance (will send you a Request for Evidence, aka RFE).
        • If you test positive (meaning you have immunity) to all three viruses, the date you tested positive is acceptable in lieu of MMR vaccination.
          • Alternatively, you may accept an automatic temporary waiver of the MMR requirement, especially if you believe you are not immune.
            • You should sequester yourself for the remainder of your pregnancy.
            • You will be expected to obtain an MMR vaccination after your baby and before leaving the hospital--USCIS often confirms compliance (will send you a Request for Evidence, aka RFE).
    • A reliable verbal or written report of having had this disease (not the vaccination) is acceptable for this one disease.
    • If you have never had Chickenpox disease, the same options as for MMR apply.
    • If you are unsure if you have ever had Chickenpox disease, it is worthwhile to check a titer.
  • MMR and Varicella vaccinations are also contraindicated for people with immuno-compromising conditions like HIV or AIDS or taking immune-suppressive drugs. All immunosuppressed applicants must undergo a chest x-ray as part of their screening process regardless of pregnancy status. Most obstetricians recommend postponing the x-ray until after delivery due to the theoretical harm it may cause the unborn baby. If you do not wish to receive the vaccines, you may be eligible for a waiver, if:
    • You are opposed to all vaccinations, AND your objection is based on moral convictions or stringent religious beliefs, not on safety concerns or due to the cost.
    Although passing your medical immeasurably increases your chances of adjusting, you do not necessarily have to pass your medical to adjust. The medical is just one part of a long and complicated process and one of many considerations. Applicants who bring skills or are in relationships important to the United States (married to an American, parent of an American, recruited by an American corporation due to special skills) may have a better chance. Tuberculosis Screening in the Pregnant Applicant
    • All pregnant applicants must be screened for tuberculosis (TB) with an IGRA blood test
    • If the test is positive, indicating that a TB infection is present, then a chest x-ray is also required.
      • Most obstetricians recommend postponing the x-ray until after delivery due to the theoretical harm it may cause the unborn baby.
      • If you choose to postpone, you will be granted all of the extra time necessary, but the processing of your medical (and the rest of your application) will be delayed accordingly.
    Also read: How Is Consistency of Vaccination Important for Immigration?

    Conclusion

    Applying for a Green Card while pregnant requires careful consideration. If you want a consultation regarding your immigration medical exam, a noted expert for the task is Dr. Steven Wittenberg Gordon. In addition to being a Civil Surgeon with over two decades of experience, Dr. Gordon is Board Certified in Family Medicine and fully trained in obstetrics. Contact us for an appointment with Dr. Gordon.

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