Low PAPP-A and low hCGb

[RedPanda25]

Just hoping for some advice please. I’ve had my screening results back in the post after my 12 weeks scan and the chance of Down syndrome is 1 in 1034 but my PAPP-A and hCGb seem low. Here are my results -

PAPP-A - mom 0.12
hCGb - mom 0.64

Does anyone know what this means and what it will mean for my pregnancy? I’ve done some googling but all I’ve done is scare myself so hoping for some first hand experience? I haven’t had any phone calls and nothing on the letter says to be concerned so I wonder if the Midwife will talk through it at my 16 week appointment?

Also on a side note (ish) do you know what the mom is? It says weight corrected? Is that weight corrected on my weight? If so, the weight they’ve detailed on my letter for me is incorrect and is higher than I am. Would that make a difference?

Thanks if you’ve read this far!

Your pappA is a little low - the MOM is something to do with an average. No idea what it stands for - median of the something. But the average is 1 so yours is low. Low pappA can be associated with slow growth and placental issues and can also mean absolutely nothing. My consultant said that there just haven’t been enough studies but different hospitals will deal with it differently. For me I had a similar pappA score to you and they wanted me to have grown scans every two weeks from 26 weeks to check on placental function which i was happy with.
Unfortunately we never got that far as I also had very low HCG (0.14 I think) and that was an indicator of trisomy 18 which our little girl had.
Ask your midwife what the care plan is for someone with such low pappA - it could be absolutely nothing and if you’re happy with that then fine. If not ask to speak to a feral medicine specialist and see if they can put your mind at rest or offer you a different care plan.
Throughout my pregnancy I have to say the biggest lesson was to be my own advocate - I pushed for answers and the doctors were amazing but perhaps wouldn’t have offered them had I not been as keen to know!
Good luck x

Fetal medicine!! Not feral

Thank you so much for your long reply and I’m so sorry about your little girl. I think I’ll call my Midwife tomorrow and ask if there is a plan in place and what it means. Thank you for all your help and advice, I will definitely push them to make sure everything is ok.

Hi OP,

I am so sorry you've stumbled into a place of worry and anxiety.

I found ARC (www.arc-uk.org) really helpful. You can ring them and discuss the results of your screening and air your worries. Our daughter had a trisomy and I found ARC a real lifeline during the screening process and post diagnosis.

Best wishes to you.
My numbers were much, much more worrying than yours, if that's of any reassurance. Here's to a wonderful, healthy outcome!

Hi, i had similar numbers to you. Papp-a was 0.09 mom and B-hcg was 0.55 mom.

My letter in the post stated that it was an unusual pattern of results. I questioned it and pushed for answers but none of the midwives understood what it meant and just said "oh I'm sure it'll be fine". In the end I saw a consultant and had extra scans as in my case the baby was measuring small, but was born perfectly healthy at 38 weeks, weighing a titchy 4lb 7.

Your results are similar to mine;
0.6 mom hcg and 0.27 mom papp-a.
Low risk for Down's syndrome etc.

I have just given birth to a very healthy boy :) 9lbs at 40+6
I had a Doppler scan at 23 weeks and an extra growth scan at 34 weeks. All normal.

I was very, very worried after the initial phone call about the low reading. It is a new area of testing and can mean something or nothing.
I took aspirin until 36 weeks but otherwise my pregnancy was completely textbook normal.

Hope my story brings you some reassurance. Good luck :)

Thank you for your reassuring replies and advice. I’m so sorry about your daughter @TheVanguardSix, thank you for sharing with me and for the link.

@Thirdload and @cinnamonwoman thank you for your reassurance and I’m so pleased everything turned out well for you. I have called my Midwife and left a message as I can’t wait till next Tuesday so hopefully she will call me back tomorrow to discuss it. Thank you again.

So my Midwife has just called and said that they don’t do growth scans for low PAPP-A in Wales as it’s a grey area and quite a new thing they test for but they will keep measuring my bump at every appointment and give me a growth chart at my appointment next week. Should I be pushing for growth scans?

Hmm. It’s really your call - my consultant said the evidence was out there but thin on the ground. Not sure how true that is now as it’s been a wee while and things change all the time.
Perhaps ask to speak with a consultant who specialises in fetal medicine they might be slightly more up to date with things and agree that you’re worth monitoring.
If not, just listen to your gut and pay attention to baby’s movements further down the line. At any point at all if you feel the slightest bit unsure bring yourself in and ask for a scan / to be monitored.
Good luck I’m absolutely sure everything will be fine x

Hi RedPanda,

I'm in the same position as you. Many trusts in Wales don't pay much attention to Low PAPP-A and hCGb which is VERY frustrating.

I'm 17 weeks now and so far I've paid for a NIPT which gave me reassurance about the trisomies. Very low risk there which reassured me. And I have rung my antenatal clinic and asked for advice because of my concerns, I've had to push but am now waiting for an appointment with a consultant and will be paying for private growth scans if the NHS won't schedule them often enough for my liking.

It's difficult but I highly recommend pushing. I'd rather be safe than sorry even though the links between the levels are still as has been previously said a grey area.

Hi RedPanda. I have had low PAPP-A results as well (but combined with high HCG so I am at high risk for DS). Currently waiting for Harmony test results. My PAPP-A was 0.29.

I did the same as you googling and reading about IUGR and placenta issues worried me, so I asked about this as well, and I was also told that they don't do additional scans or anything based on PAPP-A results here. I am in Scotland. I was told they would measure my bump and take blood pressure at every midwife appointment, and if something came up then, they would then send me for additional scans.

RCOG guidelines state that low papp-a should be considered a risk factor for small for gestational age babies and that you should be offered serial growth scans from about 26-28 weeks so I would want to discuss this with your consultant. Here’s the guideline

www.rcog.org.uk/globalassets/documents/guidelines/gtg_31.pdf

Thank you, Madame Josephine. I will make sure to mention this to my midwife at our next appointment and press for additional scans, especially if the low PAPP-A turns out not to be related to DS.

Update for anyone in Wales/Scotland and aren't being routinely monitored.

I had my consultant appointment this morning after a bit badgering to get one and she offered me growth scans straight away without me even having to ask. This is what they should be doing for low PAPP-A, regardless of what your trust says so if you're not happy please push for it! Baby comes first and should be monitored accordingly.

Don't be afraid to question what you're being told! I'd rather be labelled neurotic than lose my baby due to SGA!

Kellaree, I was going to ask my midwife about this on Friday but today I got a call from the midwife at fetal medicine who I’d talked to last week about my concerns and she said she’d organised a growth scan for me for 28 weeks. I’m hoping to have them regularly from then on but I guess that’s something I can discuss with my consultant at the appointment.

Great news! Keep pushing for scans if you're not happy!