Understanding Blood Tests During Pregnancy
What are the blood tests done at ANC, what do they measure, and what do the results mean?
18/08/2026
Haemoglobin — Checking for Anaemia
The haemoglobin (Hb) test measures the amount of red blood cells in your blood. Anaemia is defined in pregnancy as a haemoglobin level below 11.0 g/dL in the first and third trimesters, or below 10.5 g/dL in the second trimester (WHO thresholds). The Rwanda DHS 2019–20 found that approximately 16% of pregnant women in Rwanda had some degree of anaemia.
Mild anaemia is treated with increased iron supplementation and dietary counselling. Moderate-to-severe anaemia (Hb below 7–8 g/dL) may require blood transfusion, particularly in the third trimester when the risk of haemorrhage at delivery is greatest. Severe anaemia significantly increases the risk of dying from blood loss during or after childbirth.
Blood Type and Rhesus Factor
Blood typing identifies your blood group (A, B, AB, or O) and your rhesus (Rh) factor — positive or negative. This information is critical in two scenarios: first, if you need a blood transfusion during or after delivery, the correct blood type must be available; second, if you are Rh-negative and your baby is Rh-positive, a condition called Rh incompatibility can develop that causes your immune system to attack your baby's red blood cells in a subsequent pregnancy.
Rh-negative pregnant women are given an injection of anti-D immunoglobulin at certain points in pregnancy and after delivery to prevent sensitisation. This is a routine and very important intervention. If your blood type result shows you are Rh-negative, your provider will explain what this means for your care.
HIV Test
HIV testing is offered to all pregnant women in Rwanda at their first ANC visit. If you have not been tested recently, testing again in the third trimester is also recommended. Rwanda's Prevention of Mother-to-Child Transmission (PMTCT) programme is one of the most successful in Africa — mother-to-child HIV transmission has been reduced from over 30% in the early 2000s to less than 2% nationally.
If your HIV test is positive, you will immediately begin antiretroviral therapy (ART) — free at all public health facilities. ART reduces the viral load in your blood to undetectable levels, protecting your baby during pregnancy, delivery, and breastfeeding. Your baby will also receive a short course of antiretroviral prophylaxis after birth. This combination of interventions gives your baby a greater than 98% chance of being born HIV-negative.
Syphilis Test (RPR)
Syphilis is a bacterial infection caused by Treponema pallidum, transmitted sexually and from mother to baby during pregnancy. The rapid plasma reagin (RPR) test screens for syphilis in all pregnant women at the first ANC visit in Rwanda. Congenital syphilis — syphilis transmitted to the baby — causes stillbirth in approximately 25% of affected pregnancies and severe disability (bone malformation, deafness, blindness, neurological damage) in surviving babies.
The treatment for syphilis in pregnancy is a single injection of benzathine penicillin G — simple, effective, cheap, and free at Rwanda public facilities. Partners must also be tested and treated. Early detection and treatment completely prevents congenital syphilis. This is one of the most powerful examples of how a routine ANC blood test saves infant lives.
Blood Glucose Testing
Blood glucose testing may be ordered if your urine shows glucose, if you have risk factors for gestational diabetes (previous GDM, family history of type 2 diabetes, obesity, a previous large baby), or as a routine screen at around weeks 24–28. A fasting blood glucose test or an oral glucose tolerance test (OGTT) confirms or rules out gestational diabetes.
Management of confirmed gestational diabetes includes dietary modification (reducing refined carbohydrates and sugars, increasing fibre), regular blood glucose monitoring, and sometimes insulin therapy if diet alone is insufficient to control blood glucose levels. Well-controlled gestational diabetes significantly reduces the risk of complications for both mother and baby.
Related Articles
ANC: More Than Just a Clinic Visit
Antenatal care is a comprehensive programme of health checks, tests, treatments, and education — not just a routine appointment. Here is what ANC actually delivers for you and your baby.
Read articles
When Should I Start ANC?
Rwanda MoH and WHO both recommend starting ANC before 12 weeks. Here is why early registration is critical and what to do if your pregnancy was discovered late.
Read articles
How Many ANC Contacts Should I Have?
Rwanda MoH recommends a minimum of four ANC contacts, while WHO recommends eight or more. Here's the schedule, what each contact delivers, and why none should be missed.
Read articles