Pregnancy and Blood Tests: A Complete Guide for Expectant Mothers in Ghana


 


Antenatal care in Ghana has improved dramatically over the past two decades, with increasing proportions of pregnant women receiving four or more antenatal visits. Yet the quality and completeness of blood tests offered during these visits varies significantly between facilities, and many women receive results they do not understand or are not given the information needed to make informed decisions about their care. This guide covers every major blood test recommended during pregnancy, why it is done, and what the results mean.

First Trimester Tests (Weeks 1–13)

Blood Group and Rhesus (Rh) Factor

Determining your blood group (A, B, AB, or O) and Rhesus factor (positive or negative) is the first essential test of pregnancy. If you are Rhesus-negative and your baby's father is Rhesus-positive, your baby may be Rh-positive. During delivery (or miscarriage, amniocentesis, or abdominal trauma), small amounts of fetal blood can enter the maternal circulation. If this happens, a Rh-negative mother may produce antibodies against Rh-positive red blood cells. These antibodies don't affect the current pregnancy but can cross the placenta in future pregnancies and destroy a Rh-positive baby's red blood cells — causing haemolytic disease of the newborn (HDN), a potentially life-threatening condition causing severe jaundice and anaemia in the newborn.

Prevention is straightforward: Anti-D immunoglobulin injection given to Rh-negative mothers at 28 weeks gestation and within 72 hours of delivery (or any sensitising event) neutralises fetal Rh-positive cells before the mother's immune system can develop a response. This intervention has essentially eliminated severe HDN in countries where it is systematically applied.

Full Blood Count

Baseline haemoglobin at booking establishes pre-pregnancy iron status. Pregnancy increases blood volume by approximately 50% while red cell mass increases by only 25%, producing a physiological dilutional anaemia — the haemoglobin naturally falls during pregnancy even in well-nourished women. The WHO defines anaemia in pregnancy as haemoglobin below 11 g/dL in the first and third trimesters and below 10.5 g/dL in the second trimester. Severe anaemia in pregnancy (below 7 g/dL) significantly increases risks of preterm birth, low birth weight, perinatal mortality, maternal mortality from postpartum haemorrhage, and poor neurodevelopment in the child.

Haemoglobin Electrophoresis (Sickle Cell Screen)

All pregnant women in Ghana should have haemoglobin electrophoresis to identify their haemoglobin genotype. If the mother is AS, SS, SC, or has another haemoglobin variant, the father should also be tested. Couples where both partners are carriers (AS/AS, AS/SC, etc.) face a significant risk of having a child with sickle cell disease and should receive genetic counselling regarding their options.

HIV Test

Universal HIV testing at the first antenatal visit is national policy in Ghana. This is not because HIV is assumed — it is because identifying HIV-positive pregnant women early allows immediate initiation of antiretroviral therapy, which reduces mother-to-child transmission (MTCT) of HIV to below 2% (compared to 20–45% without treatment). Preventing MTCT is one of the most cost-effective health interventions in global medicine. Repeat testing in the third trimester is recommended for women who initially tested negative but remain at risk.

Hepatitis B Surface Antigen (HBsAg)

HBsAg-positive mothers have a high risk of transmitting HBV to their newborn during delivery — and perinatal transmission is the most common route of acquiring chronic Hepatitis B in high-prevalence countries. Prevention requires that the newborn receives HBV vaccine within 24 hours of birth, plus Hepatitis B immunoglobulin (HBIg) if the mother has high viral load. HBsAg-positive mothers may also benefit from antiviral therapy in the third trimester if their viral load is high. All of this depends on knowing the mother's status — which requires testing.

VDRL/RPR — Syphilis Screen

Syphilis in pregnancy causes miscarriage, stillbirth, preterm birth, and congenital syphilis in the newborn (causing bone deformities, neurological damage, and blindness). It is easily treated with a single injection of penicillin when caught early. Syphilis screening at booking (and in the third trimester in high-risk situations) is essential antenatal care. Ghana's prevalence of syphilis in pregnant women, while declining, remains significant.

Urine for Protein and Culture

Pre-eclampsia — hypertension in pregnancy combined with proteinuria after 20 weeks — is a leading cause of maternal and perinatal mortality in Ghana. Screening for proteinuria at every antenatal visit allows early detection of pre-eclampsia before it progresses to eclampsia (seizures). Urine culture screens for asymptomatic bacteriuria — bacteria in the urine without symptoms — which in pregnancy significantly increases risk of preterm labour and pyelonephritis if untreated.

Second and Third Trimester Tests

Fasting Blood Glucose / OGTT for Gestational Diabetes

Gestational diabetes mellitus (GDM) — high blood glucose developing for the first time during pregnancy — affects an estimated 5–15% of Ghanaian pregnancies. It causes macrosomia (large baby), birth complications, neonatal hypoglycaemia, and significantly increases both mother's and child's lifetime risk of type 2 diabetes. The oral glucose tolerance test (OGTT) — drinking 75g of glucose solution and measuring blood glucose at 1 and 2 hours — should be offered between 24–28 weeks. Diagnosis requires specific glucose thresholds to be met.

Repeat Haemoglobin at 28–32 Weeks

Iron deficiency anaemia is common in the third trimester due to the accelerating iron demands of the growing fetus and placenta. Repeat FBC allows identification and treatment of anaemia before the haemorrhagic risk of delivery.

Malaria Testing

In Ghana, malaria in pregnancy is associated with severe maternal anaemia, low birth weight, preterm birth, and perinatal death. Intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine — given at each antenatal visit from 13 weeks, minimum 3 doses — is national policy in Ghana and should be offered and documented at each visit.

�� Every antenatal blood test serves a specific purpose that could save your life or your baby's. Understand what you are being tested for and ensure you receive and discuss your results at every visit.

�� Get instant interpretation of your lab results — visit https://VincentAkwas.github.io/lablens — free, detailed clinical commentary for every value.

 

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