Under federal law, employers generally cannot ask about pregnancy or require a pregnancy test during a pre-employment medical exam unless the inquiry is job‑related and consistent with business necessity. The Pregnancy Discrimination Act of 1978, which amended Title VII, prohibits discrimination based on pregnancy, childbirth, or related medical conditions, and the Pregnant Workers Fairness Act (PWFA) final regulations released in 2024 clarify that pregnancy‑related conditions are covered disabilities that may require reasonable accommodation. As of July 2026, many states have updated their maternity leave guides, reinforcing that pre‑employment exams must focus on the ability to perform essential job functions rather than on an applicant’s reproductive status. Employers who rely on outdated forms that include pregnancy questions risk violating both federal and state anti‑discrimination statutes.
The rationale behind these rules is that pregnancy is not a condition that predicts job performance, and using it as a screening tool undermines the purpose of the ADA‑allowed medical examination, which is to assess fitness for specific duties. The PWFA goes further by obligating employers to engage in an interactive process and provide accommodations for known pregnancy‑related limitations unless doing so would cause undue hardship. Consequently, a lawful pre‑employment exam should measure physical or mental abilities directly tied to the job, such as lifting requirements for a warehouse role, without asking whether the applicant is pregnant or planning to become pregnant.
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Employers should begin by reviewing each job description to identify any truly essential functions that necessitate a medical assessment. If such functions exist, the exam must be designed to evaluate the ability to perform those tasks, and any medical provider conducting the exam must be instructed to avoid pregnancy‑related questions. Training HR staff and supervising physicians on permissible inquiries helps ensure consistency, and retaining documentation that shows the exam’s job‑related necessity can protect the organization if a claim arises. After a conditional offer is made, employers must be prepared to discuss accommodations for pregnancy‑related needs through the interactive process.
Job applicants who encounter a pregnancy‑related question or test should know they have the right to refuse to answer or to ask for a justification of why the information is needed. If the employer cannot demonstrate a legitimate business necessity, the applicant may consider the request unlawful. In such cases, the applicant can first request a written explanation from the employer, then consult the EEOC’s guidance on pre‑employment inquiries, and if necessary file a charge with the EEOC or the relevant state fair employment agency within the applicable filing period (generally 180 days, extended under some state laws).
Common mistakes include using a standard pre‑employment questionnaire that still contains a pregnancy checklist, assuming that such questions are routine because they appear on older forms. Another error is treating pregnancy as an automatic disqualifier and withdrawing a conditional offer without first engaging in the accommodation dialogue required by the PWFA. Some employers also mistakenly believe that state‑specific maternity leave laws allow them to screen out pregnant candidates, when in fact those laws often strengthen protections rather than create exemptions.
If an employer persists in requesting a pregnancy test despite lacking a job‑related justification, the applicant should escalate the matter by contacting the EEOC or state agency, providing any correspondence that shows the request was made. Employers facing uncertainty should seek legal counsel before finalizing any pre‑employment medical protocol, especially when operating in multiple jurisdictions with varying state requirements. Proactively aligning exam practices with the PWFA’s reasonable accommodation framework and the PDA’s non‑discrimination mandates reduces litigation risk and promotes fair hiring practices.
Finally, the safest approach is to limit the pre‑employment medical exam to assessments of essential job functions, avoid any pregnancy‑related inquiries, and be ready to accommodate pregnancy‑related needs after a hire is confirmed. This approach complies with the PWFA’s 2024 final regulations, the PDA, and the growing body of state maternity leave guidance effective in 2026, helping organizations avoid costly claims while supporting inclusive workplaces.