The essentials

A premarital screening test is a set of blood tests done before marriage. Most panels look for inherited blood disorders, such as sickle cell disease and thalassemia, and for infections such as HIV and hepatitis B and C. Saudi Arabia and several neighboring countries require it. In most other countries it is optional, and the same tests are offered as carrier screening before pregnancy.

A blood test before marriage tells a couple, before they plan children, whether both partners carry the same inherited blood disorder. It can also find infections that one partner could pass to the other. This guide walks through a typical report, explains how to read the results as a couple and sums up the rules by country. Most lines come from a complete blood count (CBC) and a few antibody tests.

What does a premarital blood test include? A report, annotated

There is no single international panel. The Saudi program checks sickle cell disease, thalassemia, hepatitis B, hepatitis C and HIV[1]. Other labs often add the blood group and rubella immunity.

Fictitious example of a premarital screening report for one partner (United States format)
TestResultReference rangeFlag
Hemoglobin11.2 g/dL11.5-15.5 g/dLL
MCV (mean corpuscular volume)64 fL80-100 fLL
MCH (mean corpuscular hemoglobin)20.5 pg27-33 pgL
Hemoglobin A2 (HPLC)5.2%Under 3.5%H
Hemoglobin SNot detectedNot detected
ABO group and Rh(D)O, Rh positive-
Rubella IgG42 IU/mL (immune)Immune: 10 IU/mL or more
Hepatitis B surface antigen (HBsAg)NonreactiveNonreactive
Hepatitis C antibodyNonreactiveNonreactive
HIV-1/2 antigen/antibodyNonreactiveNonreactive
  1. Small red cells (low MCV and MCH): the first clue. An MCH below 27 pg is the point where screening programs look further for thalassemia[11]. Iron deficiency can give the same picture.
  2. Hemoglobin A2 at 3.5% or more: this points to beta thalassemia[11]. With small red cells, it is the usual pattern of a carrier, or "trait".
  3. Hemoglobin S not detected: no sickle cell gene.
  4. Blood group: it never decides whether two people can marry; the Rh factor matters in pregnancy.
  5. Rubella IgG immune: protected against rubella, which matters before a pregnancy.
  6. Infections nonreactive: no sign of hepatitis B, hepatitis C or HIV.

Got a premarital report full of indices, percentages and "nonreactive" lines? BloodSense reads every line with you and turns it into clear questions for your counseling visit.

Explain my premarital results

Which tests are on a premarital screening panel, and what does each one check?

The usual premarital screening tests, what they look for and the result to expect
TestWhat it looks forUsual resultFull guide
Complete blood count with red cell indicesAnemia and small red cells, the first sign of a thalassemia traitMCV 80-100 fL; MCH 27 pg or more[11]MCV blood test
Hemoglobin electrophoresis or HPLCAbnormal hemoglobins (S, C, E) and a high hemoglobin A2No variant; HbA2 under 3.5%[11]Sickle cell disease
Hepatitis B surface antigenCurrent hepatitis B infectionNonreactiveHBsAg test
Hepatitis C antibodyPast or current hepatitis CNonreactiveHepatitis C
HIV antigen/antibodyHIV infectionNonreactiveHIV test results
Syphilis test (RPR, VDRL or antibody)Syphilis; included by some labs and countriesNonreactiveRPR test
ABO group and Rh(D)Rh-negative status, important in a future pregnancyGroup and Rh reportedBlood type test
Rubella IgGImmunity to rubella before pregnancyImmuneTORCH panel

Carrier screening can go further: US genetics experts suggest offering a wider list of recessive conditions to everyone planning a pregnancy, whatever their ancestry[10]. Cystic fibrosis was the first condition offered this way[10].

Is a blood test required before marriage? Rules by country

  • Common Saudi Arabia: the premarital screening program was set by law in December 2003 and started in February 2004[3]. It covers sickle cell disease, thalassemia, hepatitis B, hepatitis C and HIV. The Ministry of Health advises testing at least three months before the wedding; the certificate is valid for six months, and more than 300 centers offer it[1].
  • Common The Middle East: eight countries in the region run mandatory premarital screening and counseling for beta thalassemia[4].
  • Possible Optional carrier screening: in the United States, information about carrier screening should be given to every pregnant woman, and the test is ideally done before pregnancy[9]. Many countries in Europe, Asia and Australia run thalassemia prevention programs built on carrier testing, counseling and prenatal diagnosis[6].
  • Rare Laws that were dropped: France ended its compulsory premarital medical certificate with a law of December 20, 2007; the examination remains available for those who want it[7]. In the United States, Montana repealed its premarital blood test section in 2019[8].

Why the focus on blood disorders? Around 7% of pregnant women worldwide carry a significant hemoglobin gene, and over 1% of couples are at risk of having an affected child[5]. In the first six years of the Saudi program, 4.5% of people tested carried or had sickle cell disease, and 1.8% beta thalassemia[3].

How do you read premarital test results as a couple?

Read both reports together: a carrier result matters only in combination with the partner's.

One partner carries a trait, the other does not

This is a "compatible" result. The diseases on the panel are recessive: a child is affected only when it inherits an altered gene from each parent[14]. Children may be carriers themselves. When one person is found to be a carrier, the partner should be offered testing[9].

Both partners carry a trait

This is an "at-risk" or "incompatible" result. When both parents carry the sickle cell gene, each child has a 1 in 4 chance of sickle cell disease, a 1 in 2 chance of being a carrier, and a 1 in 4 chance of neither[13]. This chance applies to every pregnancy[13]. The Saudi program also counts a sickle cell carrier with a beta thalassemia carrier as at risk[3]. Genetic counseling is then offered[9]; in Saudi Arabia, the couple is referred to a counseling clinic[2]. The decision to marry stays with the couple: in the Saudi program, certificates were issued whatever the result, and following the advice was voluntary[3].

Small red cells but a normal hemoglobin A2

Screening programs read this pattern as possible iron deficiency or alpha thalassemia trait[11]. A ferritin test checks iron stores; see also our guide to iron deficiency. If iron is normal, DNA testing may be suggested. See our MCH guide.

A reactive infection test

A reactive screening result is not a diagnosis on its own: it is usually confirmed with a second test. Our page on reactive and nonreactive results explains these words. For a wider check, see our guide to STI testing.

Different blood groups or an Rh-negative partner

Blood groups never make a couple "incompatible". The Rh factor matters only in pregnancy: when the mother is Rh negative and the baby Rh positive, injections of anti-D immune globulin (RhoGAM) prevent problems[15]. A Coombs test is the antibody check done during pregnancy.

How should you prepare for a premarital blood test?

  • Test early: in Saudi Arabia, at least three months before the wedding[1].
  • No fasting is needed for hemoglobin tests[12] or antibody tests. Ask if other tests are added; our page on fasting before a blood test lists which ones need it.
  • Mention a recent transfusion: a transfusion in the last 12 weeks can change hemoglobin test results[12].
  • Bring your vaccination record: documented rubella vaccination counts as evidence of immunity[16].
  • Bring your family history: a relative with sickle cell disease or thalassemia, or a marriage between relatives.

When should you see a doctor about premarital results?

When to see a doctor

  • Emergency: call 911 if a person with sickle cell disease has chest pain, trouble breathing, signs of a stroke such as sudden weakness or trouble speaking, or a high fever.
  • Within 24 to 48 hours if a test for HIV, hepatitis B or hepatitis C comes back reactive, to arrange confirmation and care.
  • At your next appointment for a carrier result, an at-risk couple result, small red cells with a normal hemoglobin A2, or no immunity to rubella.

Questions to ask your doctor

  1. Am I a carrier of sickle cell disease or thalassemia, and which type?
  2. Should my partner be tested, and with which tests?
  3. Could my small red cells come from low iron instead of a trait?
  4. If we are both carriers, what are our options, and can we see a genetic counselor?
  5. Am I immune to rubella, or should I be vaccinated before a pregnancy?

Frequently asked questions

Can two people with the same blood type, such as O+ and O+, get married?

Yes. Blood groups do not affect whether two people can marry or have healthy children. The only blood group issue in pregnancy is an Rh-negative mother with an Rh-positive baby, and it is preventable[15].

Does a premarital test check fertility?

No. The standard panel looks at inherited blood disorders and infections[1]. Fertility tests are separate and are not part of it.

Is a sickle cell or thalassemia carrier sick?

Usually not. Most people with sickle cell trait have no health problems[12], and people with one beta thalassemia gene usually have no symptoms or a mild anemia[14]. The trait matters mainly for future children.

Should married couples who were never tested get screened?

It can still be useful before a pregnancy. Experts reviewing Middle Eastern programs suggest also screening couples who married before the programs began[4].

References

  1. Saudi Ministry of Health. Premarital screening (health awareness). moh.gov.sa (accessed November 9, 2026)
  2. Saudi Ministry of Health. E-services: premarital screening service. moh.gov.sa (accessed November 9, 2026)
  3. Memish ZA, Saeedi MY. Six-year outcome of the national premarital screening and genetic counseling program for sickle cell disease and β-thalassemia in Saudi Arabia. Ann Saudi Med. 2011;31(3):229-235. doi:10.4103/0256-4947.81527 (accessed November 9, 2026)
  4. Saffi M, Howard N. Exploring the effectiveness of mandatory premarital screening and genetic counselling programmes for β-thalassaemia in the Middle East: a scoping review. Public Health Genomics. 2015;18(4):193-203. doi:10.1159/000430837 (accessed November 9, 2026)
  5. Modell B, Darlison M. Global epidemiology of haemoglobin disorders and derived service indicators. Bull World Health Organ. 2008;86(6):480-487. doi:10.2471/blt.06.036673 (accessed November 9, 2026)
  6. Cao A, Kan YW. The prevention of thalassemia. Cold Spring Harb Perspect Med. 2013;3(2):a011775. doi:10.1101/cshperspect.a011775 (accessed November 9, 2026)
  7. Assemblée nationale (France). Written question no. 14989 on the premarital medical certificate, ministerial answer of June 10, 2008. assemblee-nationale.fr (accessed November 9, 2026)
  8. Montana Legislature. Montana Code Annotated 2025, section 40-1-206 (repealed, Ch. 43, L. 2019). legmt.gov (accessed November 9, 2026)
  9. American College of Obstetricians and Gynecologists. Committee Opinion No. 691: carrier screening for genetic conditions. Obstet Gynecol. 2017;129(3):e41-e55. doi:10.1097/AOG.0000000000001952 (accessed November 9, 2026)
  10. Gregg AR, Aarabi M, Klugman S, et al. Screening for autosomal recessive and X-linked conditions during pregnancy and preconception: a practice resource of the American College of Medical Genetics and Genomics (ACMG). Genet Med. 2021;23(10):1793-1806. doi:10.1038/s41436-021-01203-z (accessed November 9, 2026)
  11. NHS Sickle Cell and Thalassaemia Screening Programme. Handbook for antenatal laboratories: interpretation and reporting of antenatal screening results. 2024. gov.uk (accessed November 9, 2026)
  12. MedlinePlus. Hemoglobin electrophoresis. medlineplus.gov (accessed November 9, 2026)
  13. National Heart, Lung, and Blood Institute. Sickle cell disease: causes and risk factors. nhlbi.nih.gov (accessed November 9, 2026)
  14. MedlinePlus Genetics. Beta thalassemia. medlineplus.gov (accessed November 9, 2026)
  15. MedlinePlus Medical Encyclopedia. Rh incompatibility. medlineplus.gov (accessed November 9, 2026)
  16. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases (Pink Book): rubella. cdc.gov (accessed November 9, 2026)
  17. Centers for Disease Control and Prevention. Hepatitis B: diagnosis and testing. cdc.gov (accessed November 9, 2026)
  18. US Preventive Services Task Force. Screening for hepatitis C virus infection in adolescents and adults: recommendation statement. JAMA. 2020;323(10):970-975. doi:10.1001/jama.2020.1123 (accessed November 9, 2026)
  19. US Preventive Services Task Force. Screening for HIV infection: recommendation statement. JAMA. 2019;321(23):2326-2336. doi:10.1001/jama.2019.6587 (accessed November 9, 2026)

This article is general health information. It does not replace a medical examination, diagnosis or genetic counseling. A carrier or reactive result should always be discussed with a health professional.