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  3. Premarital screening

What is Premarital Screening? 

Premarital screening comprises a few tests that are performed before marriage to prevent the transmission of diseases from one partner to the other and to provide them with options to plan for a healthy family.

It includes the following tests:

  • Blood group: This test checks what your blood type is. Blood groups depend on the type of protein, called an antigen, present on your red blood cells. It is passed down to you from your parents. There are four major blood types - A, B, O, AB. However, a blood group test also determines the presence of a substance called Rh factor on your RBCs. Testing the Rh factor is important as Rh type plays an essential role during pregnancy. If the father is Rh-positive and the mother is Rh-negative, the mother will need special treatment so her body does not make antibodies (proteins produced by the immune system to fight harmful substances) against the fetal blood - this would happen if the fetus is Rh-positive. In most cases, the firstborn is not harmed as the mother does not produce enough of the harmful substances. However, with subsequent pregnancies, the risk to the unborn baby increases. Read more: Blood group test
  • Venereal Disease Research Laboratory (VDRL) test: The VDRL test is a screening test for the diagnosis of syphilis. It checks for the presence of antibodies in the blood against the syphilis-causing bacteria, Treponema pallidum.
  • Hepatitis B surface antigen (HBsAg) test: Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). It can be transmitted through the blood, vaginal fluid and seminal fluid. The HBsAg test is a blood test that checks for the hepatitis B surface antigens (proteins present on the surface of the hepatitis B virus). In a newborn with hepatitis B infection could damage the liver, which may lead to liver cancer.
  • HIV-1 and HIV-2 test: It is a blood test that is performed to check if you have a human immunodeficiency virus (HIV) infection. HIV virus attacks and weakens the immune system making one prone to infections. This test checks for both HIV antigens (part of the virus against which antibodies are formed) and antibodies. Sexual contact can spread HIV.
  • Haemoglobin electrophoresis test: Haemoglobin is the chemical present in the red blood cells that transport oxygen to the body. The common types of haemoglobin present in adults are haemoglobin A and haemoglobin A2. Haemoglobin F is present in newborn and foetal blood. In addition, there are more than 350 varieties of abnormal haemoglobin - some of the common types are haemoglobin S and haemoglobin C. Electrophoresis is a method that is used to separate the normal and abnormal types of haemoglobin. The presence of abnormal haemoglobin or an abnormal amount of normal haemoglobin in blood can indicate the presence of a disease. For example haemoglobin S is present in sickle-cell anaemia.
  1. Why is Premarital Screening done?
  2. How do you prepare for Premarital Screening?
  3. How is Premarital Screening done?
  4. What do Premarital Screening test results mean?

Why is Premarital Screening done?

 Premarital Screening is done to:

  • Control the transmission of infectious diseases, such as hepatitis B and HIV
  • Control the spread of genetic diseases, such as thalassaemia and sickle-cell anaemia.
  • Reduce the financial burden of the family (from the treatment of these conditions) in case any of the diseases show up later.
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How do you prepare for Premarital Screening?

You do not need any preparation for the blood group, HBsAg, VDRL and HIV tests.

Let your healthcare provider know about all the drugs, including supplements, vitamins, herbs, non-prescription and illegal drugs, that you are using. This is because, the results of HBsAg test and haemoglobin electrophoresis test, can be affected by certain drugs.

Also, inform your doctor if you have had any recent blood transfusions as it may affect the test results.

Wear a short-sleeved shirt or t-shirt for the test. 

How is Premarital Screening done?

A blood sample is required for all the tests in this panel.

A lab technician will obtain the sample in the following way:

  • They will tie a tight band (tourniquet) on your upper arm and wipe a site below the band with an antiseptic solution.
  • Using a needle and syringe, they will withdraw a few millilitres of blood from a vein in your arm. When the needle is inserted, you may feel a pricking sensation.
  • The sample will be put into a labelled bottle and sent to the laboratory for testing.

After the test, you may get a bruise at the injection site that will fade over time. You may feel dizzy or faint during or after the test.

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What do Premarital Screening test results mean?

Normal results:

The normal results are as follows:

  • Blood Group: Your blood group may be from one of the following blood groups: 

    • Type A
    • Type B
    • Type O
    • Type AB

Your blood type may be either Rh-positive or Rh-negative.

  • For the VDRL test, the normal result is negative, which indicates the absence of antibodies to syphilis in the blood sample.
  • For HBsAg test, the normal result is non-reactive or negative, which indicates the absence of hepatitis B surface antigen in the blood sample.
  • The normal HIV-1 and HIV-2 results are negative. A negative result can also mean that although you have HIV, it is too early to be diagnosed.
  • Haemoglobin electrophoresis test:
    • Haemoglobin A1: 96.5%-98.5% of total haemoglobin
    • Haemoglobin A2: 1.5%-3.5% of total haemoglobin
    • Haemoglobin F: 0%-1% of total haemoglobin
    • Abnormal haemoglobin: absent

Abnormal results:

If the VDRL test result is positive, it indicates that you have syphilis. A confirmatory test for syphilis should be done in case of positive VDRL test results. In some conditions, the test may give false-positive results. These conditions are as follows:

For HBsAg test, abnormal results are positive or reactive. It could indicate that HBV infection is active. In general, you should recover in six months. However, if you do not recover in six months, the virus can stay in your blood, harm your liver and spread to others.

For HIV-1 and HIV-2 test, if your result is positive, you will need a confirmatory test. If both these tests are positive, it indicates that you have HIV. However, it does not indicate that you have AIDS.

For the haemoglobin electrophoresis test, different values indicate the following conditions:

  • The levels of haemoglobin A2 and F above normal may indicate a mild form of thalassaemia. 
  • Very low haemoglobin A and high haemoglobin F values indicate a severe form of thalassaemia.
  • High levels of haemoglobin F may be present in a condition known as hereditary persistence of foetal haemoglobin.
  • If haemoglobin S is present in high amounts, it indicates the presence of sickle-cell disease; whereas, if haemoglobin S is present in moderate quantities, it indicates the presence of sickle-cell trait.
  • The low levels of haemoglobin C indicate haemoglobin C trait. If higher levels are present, it may indicate haemoglobin C disease, which may cause an enlarged spleen and anaemia.
  • The low values of haemoglobin E can mean haemoglobin E trait and higher levels can mean haemoglobin E disease, which can cause anaemia with reduced size of red blood cells.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Benioff Children's Hospital [internet]. University of California. San Francisco. US; Medical Tests
  2. The Embryo Project Encyclopedia: Arizona State University [Internet]. US; Rh Incompatibility in Pregnancy
  3. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; Adult and Children's Health Encyclopedia
  4. AIDS Info [Internet]. National Institute of Health. U.S. Department of Health and Human Services. Maryland. US; Unerstanding HIV/AIDS: Fact Sheets
  5. Centers for Disease Control and Prevention [internet]. Atlanta (GA): US Department of Health and Human Services; HIV Basics
  6. Minority HIV/AIDS Fund [Internet]. U.S. Department of Health and Human Services; Understanding HIV Test Results
  7. Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; HIV and AIDS
  8. Merck Manual Consumer Version [Internet]. Kenilworth (NJ): Merck & Co. Inc.; c2018. Human Immunodeficiency Virus (HIV) Infection
  9. National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Blood Tests
  10. US Department of Veteran Affairs [Internet]. Washington DC. US; What is HIV?.
  11. UW Health: American Family Children's Hospital [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; Medical Tests
  12. Michigan Medicine: University of Michigan [internet]. US; Health Library
  13. Nemours Children’s Health System [Internet]. Jacksonville (FL): The Nemours Foundation; c2017; Blood Test: Hemoglobin Electrophoresis
  14. National Health Service [internet]. UK; Blood Tests
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