Low PAPPA levels. Should I worry?

[rightontime]

I have recieved a letter saying that the blood taken at my 12week scan showed low PAPPA levels and could lead to slow growth of the baby. I am now 14+3 now and am a bit worried. This is my 3rd baby and I have never had the nuchal test before.

I quickly googled low PAPPA and was completely confused with all the medical jargon that came up.

Please can someone explain to me in simple terms what causes PAPPA to be low. I barely ate from conception to 13 weeks due to vomiting could that cause low levels? The baby was measuring exactly right for dates at the 12week scan.

Also what implication does it have? What will I need to do to make sure my baby is ok?

Please someone give me some reassurance as this letter doesn't give me any clues as to how worried I need to be and has just said they will do an additional check at the 20weeks scan.

I am 20 and have had 2 babies 1 at 41+6 and 1 at 41+2 and they weighed 8lb2 and 8lb3. My risk for downs came back at 1:160

I have also posted this in pregnancy but no replies as yet so thought I would try here too.

Hi rightontime,

Can't help personally, but there will be ladies along soon who can - promise! Just didn't want to leave you here alone. For what it's worth, I would say if there was a real problem, they would have got you in before 20 weeks, after all that's nearly 6 weeks to wait. Can you call your midwife?

Throwing up will not have done your baby any harm at all, you maybe but not baby! I threw up continuously with DS1, even ended up on tablets and was a whisker away from being admitted to hospital. I panicked like mad but my doctor put me straight; when you are pregnant any food/ water/ goodness goes to baby first, then mum. Your body is totally designed to nuture little one, so although you are feeling like sh*t, little bean is bouncing round happy as Larry, thank you very much!

Hopefully one of the others will be along soon, but for now take a deep breath and try to relax if you can xxxxx

Thank you. Just really worried as it seems to be one of the markers for downs and DH and I had decided that if we were faced with a DS baby we would terminate. However because the cut of for more tests is 1:150 and we are 1:160 we are not thought to be high enough risk for more testing. Just really worried.

Hi, I had the same. It's a worrying time and I couldn't find out much info at the time, despite obsessive googling. Did you have a nuchal or just triple test? If a nuchal, was the scan showing any markers? I know it doesn't help right now, but at the 20 week scan they will look for soft markers so you should have more of a clue for what is happening. Having said that, if you think about it, 160 in 1 is still a very low risk - around half a percent chance. It helped me to focus on that, maybe it helps you too?

For what it's worth, my obsessive googling revealed that low papp a can often associated with having a boy!

And I have a very healthy little boy, I should add!

Hi, I had a nuchal scan. I don't know much about what the look for but the sonographer said that the scan looked fine to her. I did see something suggesting that it was associated with boys. I think from when I concieved I am having a boy anyway so we shall see. I just don't want to get too excited if something is going to be wrong. The relief I felt being classed as low risk (although 1:160) is now blown out of the water. I'm sure it will pass but I don't know how to enjoy and relax about being pregnant when feeling this worry. With my previous 2 boys I never had the nuchal or any DS screening tests so never had this worry.

I wish I had refused the test now as I can't see a way to put my mind at rest.

firstly i'm sorry that you're having all of this worry!

yes, low papp-a i think can be related to slow growth rate, but as your baby is measuring right on track at the moment i think that maybe they sent the letter to you as a 'pre-warning'. with regard to down syndrome and other chromosome related problems, it's not just the blood levels taken into account but the nuchal fold and your age. i had low papp-a nad low hcg at my NT scan, and googled away for hours, but actually i think it did more harm than good.
if they're worried about growth (and that seems to be their only concern) then i would personally call your mw and request a growth scan at about 16/17 weeks just to put your mind at rest. at that gestation they would also be able to see a little better whether there is anything else that worries them.
sorry, that sounded really bleak. to be honest i think that it is just the hospital being over cautious, but of course you're pregnant and every little thing is going to concern you!!! push for an earlier scan. i wouldn't go down the amnio route, especially if it wouldn't make a difference to you. but an earlier scan may be able to pick up other problems if there were any.

not sure if i've been any help, i'm sure there'll be someone else along who has more experience!
best of luck and hope that your worry is over soon xxxxx

I know how you feel, it's horrible and your mind won't stop turning it over and over.

I agree that an earlier scan than 20 weeks is a good thing to ask for. If growth looks fine, and no soft markers for DS (I think they check nose bone, heart size, etc. But I'm by no means an expert so not sure), then it should help you to feel reassured hopefully.

Sorry there's nothing I can say to help stop your whirring brain - wish I did!

I do have a 16 week scan booked already to check for a genetic condition so will ask for a growth check at the same time.

I can't really know anything without knowing how well the baby is growing so will just have to stop googleing and wait for scan in a week and half.

Thanks for your support everyone.

I had very low Papp-a in my second pregnancy and hcg was also raised and nuchal fold high end of normal giving me a 1:15 chance of down syndrome. I had a cvs which gave the all clear but then moved onto the thing you're concerned about - low growth rate due to low Papp-a.

I contacted Antenatal Results and Choices who were very reassuring and said that there MAY be a slightly increased risk of growth issues but the research in this area was very limited. Anyway I worried away anyway like you. Growth at 20 weeks was bang on normal but I wanted further reassurance so had a private scan at 28 weeks (baby measuring big!) and the senior sonographer said growth probs from low Papp-a were very rare. I had an nhs scan at 34 weeks and again large for dates. My little boy was born 3 weeks ago at 39 weeks weighing 8lb 6oz, bigger than my first son whose Papp-a was normal.

I hope this provides you with some reassurance.

Claire x

Claire. that is very reassuring to know. It is awful that they telephone with high risk of downs but that for something like PAPP-A they can send you a vague letter and leave you to worry.

Glad that it is quite rare and so pleased for you that you have a lovely healthy baby. Congratulations. x

I'd also recommend calling ARC (020 7631 0285) if you want more info about PAPP-A - they were really helpful when I got my nuchal results back with a borderline high risk result.

At the time I spoke to them I didn't have the specific numbers for the blood results but I do remember her saying that it's not particularly helpful to look at them in isolation as there is natural variation in these results anyway - ie: some people will have slightly higher than average PAPP-A, some will be slightly lower.

I’ve just had my 13 week scan everything was fine I also had my chromosomes bloods done I got all low risk but my Papp a was low doctor said not to worry but I can’t help but not!