Premarital screening

In short

Premarital screening tests for blood disorders such as thalassemia and sickle cell disease, and for infectious conditions including hepatitis B, hepatitis C and HIV.
In Saudi Arabia, the UAE, Bahrain and Qatar the test is legally required before marriage; in other Arab countries it is strongly recommended.
Finding that both partners carry a gene for the same blood disorder does not mean they cannot marry; it means they should understand the probabilities and have a counselling session.
If both partners are carriers, each pregnancy has a one-in-four chance of producing a child with the full disease, a one-in-two chance of another carrier, and a one-in-four chance of an unaffected non-carrier.
A positive hepatitis or HIV result opens a conversation about treatment and transmission prevention, not an automatic bar to marriage.

What this article covers

Why do Arab countries require a premarital blood test?
What conditions are screened for?
What does a carrier result actually mean?
What happens when only one partner is a carrier?
What do infectious disease results mean?
What happens after a positive or high-risk result?
How reliable is premarital screening?
Where to get screened and what it costs
What if the test was done elsewhere and results are from abroad?

Why do Arab countries require a premarital blood test?

The Gulf states and several other Arab countries made premarital screening compulsory because certain blood disorders are particularly common in their populations and because the region has elevated rates of consanguineous marriage, which can concentrate inherited disease. Saudi Arabia introduced mandatory premarital screening in 2004, initially covering sickle cell disease and thalassemia. The programme was later extended to include infectious diseases. Similar programmes followed in the UAE, Bahrain, Qatar, Kuwait and Oman.

A 2024 cross-sectional study published in the Journal of Taibah University Medical Sciences, reviewing outcomes from Riyadh over 2021 to 2022, found that a meaningful proportion of couples presenting for screening had at least one partner who was a carrier for a haemoglobin disorder. Identifying these couples before rather than after marriage allows them to receive genetic counselling and understand what each possible pregnancy outcome means in numerical terms, which they could not do without the test.

In countries where screening is not compulsory, such as Jordan, Lebanon, Egypt, Syria and Iraq, most doctors strongly recommend it, and many private hospitals and religious institutions offer it or advise couples to undertake it. The test is inexpensive, available at most private laboratories, and takes a few days for results. Whether legally required or chosen voluntarily, the purpose is the same: information, not obstruction.

What conditions are screened for?

The core of premarital screening is the haemoglobin electrophoresis test, which identifies whether either partner carries an abnormal haemoglobin gene such as the sickle cell gene (haemoglobin S) or a thalassemia variant. These conditions cause anaemia and are inherited in an autosomal recessive pattern, meaning a child needs two faulty copies to be seriously affected. Carriers, who have only one faulty copy, are usually healthy.

Most premarital screening programmes in the Gulf also include a complete blood count (CBC), which can flag anaemia and suggest iron deficiency or a blood disorder needing further evaluation. The screening then typically adds tests for three infectious conditions: hepatitis B surface antigen (HBsAg) to detect current hepatitis B infection, hepatitis C antibody, and HIV antibody testing.

Some countries include additional tests. Qatar and Bahrain have added cystic fibrosis, homocystinuria and spinal muscular atrophy to their screening panels. Rubella immunity testing is sometimes included for women, because rubella infection in the first trimester of pregnancy can cause severe fetal abnormalities. In some centres, a blood group and rhesus type are also recorded, which is relevant if there is a risk of rhesus incompatibility in future pregnancies.

What is typically covered in premarital screening

Category	Test	Why it matters
Blood disorder	Haemoglobin electrophoresis	Identifies carriers of sickle cell or thalassemia
Blood disorder	Complete blood count (CBC)	Detects anaemia, flags possible haemoglobin disorder
Infection	HBsAg (hepatitis B surface antigen)	Identifies current hepatitis B infection
Infection	Hepatitis C antibody	Identifies prior exposure to hepatitis C
Infection	HIV antibody	Identifies HIV infection
Additional (some countries)	Rubella IgG	Confirms immunity in women before pregnancy
Additional (some countries)	Blood group and rhesus type	Relevant to pregnancy management

What does a carrier result actually mean?

A carrier result for a blood disorder, for example a carrier of beta-thalassemia or of the sickle cell gene, means the person has one normal copy and one abnormal copy of the relevant gene. Carriers are almost always healthy. They do not have thalassemia major or sickle cell disease. They may have a mild, medically insignificant reduction in their red cell indices, which is often noticed incidentally on a blood count.

The question becomes clinically significant when both partners are carriers of the same condition. In that situation, each pregnancy has a one-in-four chance of the child inheriting two abnormal copies and developing the full disease, a two-in-four chance of the child being a carrier like the parents, and a one-in-four chance of the child inheriting two normal copies and not being a carrier at all. These are independent probabilities for each pregnancy, not a guarantee: two carrier parents can have three unaffected children in a row, or they can have two affected children from four pregnancies.

The Saudi national programme, reviewed in a 2019 analysis by Gosadi published in the Journal of Infection and Public Health, showed that identifying carrier couples and providing counselling led a substantial proportion to delay or reconsider marriage, while others proceeded with awareness. Neither outcome is mandated: the information belongs to the couple. Some choose prenatal diagnosis in each pregnancy; others opt for preimplantation genetic diagnosis where available; others decide to proceed and accept the outcomes as they come. The role of the health system is to provide accurate information and experienced counselling, not to make the decision.

1 in 4 chance of child with the full disease when both parents carry the same gene

1 in 2 chance of child being a carrier, healthy like parents

1 in 4 chance of child inheriting no abnormal copy at all

What happens when only one partner is a carrier?

If only one partner is a carrier and the other has two normal copies, none of their children will have the full disease. Half the children, on average, will inherit the carrier status (one abnormal copy) and half will inherit two normal copies. This is a reassuring result: no child from this pairing can develop thalassemia major or sickle cell disease from this particular gene.

However, a child who is a carrier can still pass that gene to their own children in the next generation. This is why carrier status is worth knowing and recording. If that carrier child later has a child with another carrier of the same condition, the grandchildren are back to the one-in-four risk of the full disease. Keeping a note of carrier status in a personal health record, which you can do within the Sihtak app, means this information is available when it is needed in the future.

It is also possible, though less common, for one partner to carry a gene for one blood disorder and the other partner to carry a gene for a different one. In that case, the risk calculation is specific to the combination, and genetic counselling from a specialist is the right next step to get accurate figures.

What do infectious disease results mean?

A positive result for hepatitis B surface antigen means one partner is currently infected with hepatitis B. This does not mean the couple cannot marry, and it does not mean transmission is inevitable, but it opens important medical conversations. The infected partner needs a full hepatitis B workup including viral load (HBV DNA) and liver function assessment, and the uninfected partner should be checked for existing immunity and, if not immune, should receive the hepatitis B vaccine course before or immediately after marriage.

A positive hepatitis C antibody result means the person has been exposed to the hepatitis C virus at some point. A reactive antibody screen needs to be followed up with an HCV RNA test to determine whether the infection is current or cleared. Hepatitis C is now curable in the vast majority of cases with a short course of direct-acting antiviral drugs, so a positive result, properly followed up and treated, is manageable. Transmission between stable monogamous partners is possible but the risk per year is low.

An HIV positive result is the one that generates the most anxiety, but the medical picture has changed dramatically. People on effective antiretroviral therapy have a normal or near-normal life expectancy, and with treatment their viral load is suppressed to undetectable levels, which effectively eliminates transmission risk to a partner during unprotected sex. The focus shifts to treatment, monitoring and planning for pregnancy safely. Specialist referral for both partners is essential, and the counselling at this point should be supportive rather than judgemental.

What happens after a positive or high-risk result?

In countries where screening is mandatory, the result is issued to the couple with a notation of whether the result is compatible (meaning no significant risk identified), incompatible (meaning both partners carry the same blood disorder gene or an infectious result was found) or requires further work. The word incompatible is a legal and administrative category, not a medical verdict on whether a marriage should proceed. In Saudi Arabia, for example, the couple receives counselling and the results, but proceeding to marriage remains their legal right.

Genetic counselling after a high-risk result is the key step. An experienced counsellor explains what the numbers mean, what options are available, and what support exists. The session covers prenatal diagnosis, which involves testing a pregnancy at ten to twelve weeks by chorionic villus sampling, and preimplantation genetic diagnosis for those undergoing assisted reproduction. It also covers the realistic outcomes of proceeding without intervention. Good counselling is directive about information and non-directive about decisions.

Where genetic counselling services are limited, as they are in parts of Syria, Yemen, Sudan and Iraq, a doctor or specialist nurse who is familiar with the conditions can cover the core information. Online resources in Arabic from established health institutions can supplement a brief clinical conversation. The minimum that any couple with a high-risk premarital result should receive is an accurate explanation of the numbers and a follow-up appointment to ask questions.

Steps after receiving your premarital screening results

Result day Receive results; both partners review them together with a doctor or counsellor
Week 1 to 2 Genetic counselling session if either partner is a carrier or if an infectious result was found
Week 2 to 4 Further testing if needed: HBV DNA, HCV RNA, HIV viral load, specialist referral
Before pregnancy Discuss prenatal diagnosis options with an obstetrician or genetics specialist
Each pregnancy Chorionic villus sampling or amniocentesis at the appropriate gestation if both partners are carriers

How reliable is premarital screening?

Haemoglobin electrophoresis is highly accurate for detecting the most common blood disorder carriers when the test is done at a competent laboratory using a validated method. The analysis published by Belhoul and colleagues in 2013 covering the Dubai Health Authority premarital screening programme found that the programme reliably identified carriers and provided useful epidemiological data on the prevalence of haemoglobin disorders in UAE residents.

For infectious diseases, the sensitivity and specificity of modern HIV, hepatitis B and hepatitis C tests are very high, but no screening test is perfect. A reactive result is typically repeated before it is acted upon, and a confirmatory test is done before any serious medical or social consequence follows. If you receive a reactive result that surprises you, it is reasonable to ask what confirmation testing has been done before treating it as definitive.

One limitation of the current haemoglobin electrophoresis approach is that it detects common haemoglobin variants very well but may miss some rarer gene mutations that cause thalassemia. In communities with specific rare variants, DNA-based testing rather than just electrophoresis may be recommended. This is an area where clinical genetics advice adds real value.

Where to get screened and what it costs

In Saudi Arabia, the official premarital screening programme is run through government health centres and can be done for a small administrative fee. In the UAE, the Dubai Health Authority and Abu Dhabi Health Services operate the programme. In Bahrain and Qatar, government hospitals offer it. In countries without a formal programme, the tests are available at most private laboratories, typically as a package.

Where cost is a barrier, the individual tests that form the screen are generally available separately. The complete blood count and haemoglobin electrophoresis are among the most affordable laboratory tests anywhere in the region. Hepatitis B and C tests are also inexpensive at most private labs. HIV testing is available free of charge through public health services in most Arab countries, often at dedicated clinics that offer confidential testing.

If you live in a country where mandatory premarital screening exists, note that the official result letter issued by the programme is a legal requirement before the marriage contract can be registered. Doing a private test and presenting those results in place of the official certificate is not accepted. Allow adequate time before the planned wedding date, typically at least two to three weeks, to complete the process and receive the official documentation.

What if the test was done elsewhere and results are from abroad?

If you or your partner had premarital screening done in another country, you should check whether those results are accepted by the official programme in your current country. In Saudi Arabia and the UAE, the official premarital certificate must generally be issued domestically. A prior test done abroad may inform a conversation with a doctor, but will not substitute for the official programme.

Conversely, if you had screening done in the Gulf and are now marrying in a country without a formal programme, carrying documented results is still valuable. A haematologist or internist in any well-equipped Arab country can review foreign lab results and advise on their interpretation.

If the results from abroad show a blood disorder carrier finding, bring the original report and the lab's reference method used, because haemoglobin electrophoresis results can be presented in different ways depending on whether high-performance liquid chromatography (HPLC) or cellulose acetate electrophoresis was used. A genetics specialist or haematologist can translate between methods.

Recording your premarital screening results, blood group and any carrier status in Sihtak creates a permanent reference you can share with an obstetrician, midwife or genetic counsellor when planning your first pregnancy.

Frequently asked questions

Can we still get married if both of us are carriers?

Yes. In Saudi Arabia and the other Gulf states with mandatory screening, a carrier-carrier result may be noted as an elevated-risk finding, but the couple retains the legal right to proceed with marriage. The purpose of identifying the result is to ensure the couple receives counselling before making that decision, not to prevent the marriage.

We are cousins. Does that change what the screening means?

If you are related, there is a higher chance that you both carry the same recessive gene without knowing it. For thalassemia and sickle cell in communities where these conditions are more common, the premarital screen is especially informative in this situation. The screen itself is identical; the context of consanguinity is discussed during the counselling that follows the results.

What is haemoglobin electrophoresis and is it painful?

Haemoglobin electrophoresis is a blood test done from a standard venous blood sample, the same type drawn for any blood test. It is not painful beyond the routine needle prick. The test separates different types of haemoglobin and identifies whether any abnormal type, such as haemoglobin S or haemoglobin Barts, is present.

My result shows I have sickle cell trait. What does that mean for my health?

Sickle cell trait means you are a carrier: you have one normal copy of the haemoglobin gene and one copy of the sickle cell gene. Most people with sickle cell trait are entirely healthy and have a normal life expectancy. The trait does not cause the painful crises of sickle cell disease. The only medical significance is for family planning, particularly if your partner also has sickle cell trait or a related haemoglobin variant.

If one partner tests positive for hepatitis B, can the other be protected?

Yes, effectively. The hepatitis B vaccine is highly protective, with more than 95 percent of vaccinated adults developing immunity. If one partner has hepatitis B and the other has not been vaccinated, completing the three-dose vaccine series before marriage significantly reduces transmission risk. Specialist advice should also be sought about antiviral treatment for the infected partner, which further reduces the risk.

Does the premarital test screen for all genetic conditions?

No. The current premarital screening panel covers blood disorders and selected infectious conditions. It does not screen for conditions like Down syndrome, cystic fibrosis (except in Qatar and Bahrain specifically), familial Mediterranean fever, or most other single-gene disorders. If there is a family history of another genetic condition, a separate consultation with a clinical geneticist is needed.

What is the difference between a carrier test and a prenatal test?

A carrier test, done before marriage or conception, looks at the parents' own DNA to identify whether they carry a recessive gene. A prenatal test, done during pregnancy by chorionic villus sampling or amniocentesis, looks at the developing baby's DNA to see which combination it has inherited. The premarital test identifies the risk; the prenatal test tells you what has actually happened in that particular pregnancy.

Sources

This content is for health education only and is not a substitute for medical advice. If you have symptoms that worry you, see your doctor.