Low papp-a from screening blood tests

[Mizzy19]

Am 14 weeks pregnant. Went in for my consultant appointment yesterday and was told that I've got a low papp-a (from their paperwork I saw low is when papp-a is less than 0.42MoM). Unsure what the exact figure is for myself but will find out. And that I will need regular growth scans etc. That baby is smaller than what it should be I was told.
My other screening came back as low risk with Down with 1 in 1711 and Edwards/Patau as 1 in 1125.
I wasn't told anything else. I've never heard of Papp-a, but after go ogling, it's a protein produced by the placenta. Apparently its low meaning that oxygen and food exchange isn't 100% through placenta I guess.
This is my second pregnancy.
My first one was overdue at 41+2 and baby boy was born via c section weighing 8.6pounds.
I'm a little concerned. Had anyone had this and what happened and is there real cause for concern?
Anything I could do to increase my levels?
The consultant has advised to take 150mg daily at night to improve placental blood flow and exchange. Plus I sleep on my left as it is.
If anyone could share their experiences and put my mind at rest, I'd be grateful.

[Markryb]

Hi, I. Not going to be much help in terms of advice. But my wife found out she had low PAPP-A at our midwife appointment last week. She was 26 weeks when we fount out. Its something the midwife mentioned that was in our notes and we had no idea. Apparently a letter was sent to us after the combined test. So this whole time we had no idea. We have a growth scan booked in on the 9th May. But up until now everything has been fine. And we obviously had our 20 weeks scan and everything looked good on that. Did you manage to find out what your PAPP-A score was.
I'm very annoyed as the midwife like ma y others I have heard about just gloss over it leaving you no choice but to Google it and then become terrified of all the results it gives you. We are now anxious for this growth scan.

[Mizzy19]

I forgot to ask the consultant the level of papp-a however I just realised that everything is now online so I logged into the portal midwife initially set up at week 8.
It's got all the results on there.
My papp-a levels are 0.35 Mom. I've not received any letter or been given a leaflet. No explanation at all.
No protein found in urine and BP is normal.
Been told to take 150mg aspirin daily at night through all pregnancy.
I guess it down to leading a stress free lifestyle, so been doing gentle exercise i.e. Lots of walking and I've always done spinning but just reduced the intensity. I did this throughout my last pregnancy until delivery. I guess it helps to increase the oxygen levels and mentally good for you.
I've got a uterine artery doppler scan with the anamoly scan at week 20 next alongside serial growth scans. That's what it says on the portal.
So let's see.
To be honest just reading stories online help but also cause anxiety, so I'm not going to read anymore or Google. Like you say, it's terrifying.
I've got a private scan booked at 16 weeks(£50 for gender scan and well being check) anyway, so will be reassuring hopefully. Am 14w2days in at the mo.
Good luck with the scans and be nice to know how things go.

[leah3]

@Mizzy19 you have exactly the same PAPP-A as me and I think we’re about as far along as each other. My Papp-a and high hcg made me very high risk for DS! Luckily, little one came back all clear yesterday but now I’ve got to worry about this PAPP-A! I’ve read a lot of stories of women who’ve had this though and majority of the time, baby is fine. Best of luck 🤞🏿

[Mizzy19]

@leah3 that's great news. I'm happy for you. That's a relief I bet. It's one worry after another. All we can do is stay positive. As few people have stated, healthy diet but keep eating lol. That's what I'm doing.
I'm not sure what my hcg was or is, but must be alright as no mention of it anywhere.
Got my private scan next week, hopefully all is well there.
Good luck guys @leah3 and @Markryb

[leah3]

Yes that’s literally how I feel lool! One thing after another 🤦🏽‍♀️ But it was definitely a relief. But thank you love, wishing you a safe pregnancy! Let me know how you get on 🤍

[Markryb]

Had our first growth scan today and everything was absolutely fine. Measurements were fine. Weight was above average. Position of baby and placenta was good. The doctor even said in the consultation he personally has never come across Any issues related to PAPP-A. We have another scan in 4 weeks. But it's definitely put us at ease.

Good luck.

[leah3]

@Markryb ahhh that’s good. I’ve been worrying about it! Got my midwife appointment tomorrow so hopefully I can speak to her more about it as they’ve not really told me much so far. I’ve had to do all the research! On the plus, bump is starting to grow 😀

[Mizzy19]

@leah3 same here. Got my midwife appointment tomorrow too so will be asking more about it.
That's good to hear, @Markryb , a relief and sounds all positive, so hopefully our scans go that way too. Thanks for letting us know.
And yes, @leah3 bump starting to take shape. Woohoo.

[Missingmydarling]

I hope everything is going well. When I was researching low papp-a I found lots of positive posts on babycenter I think it was. My papp-a was combined with low hcg which is a whole different ball game. Glad you've got your aspirin. Do you take it with your evening meal? Good luck with everything xxxxx

[leah3]

@Mizzy19 @Markryb just had my midwife appointment guys, I told her that the hospital said I should have extra scans but she kind of brushed it off and said my next scan booked is the 20 week one! She didn’t seem concerned about my Papp-a and high HCG but I’m not sure whether it’s because it’s not a concern or she just wasn’t bothered. It was a different midwife this time. I’m thinking to book a private one next week but conscious of having too many. Don’t know what to do 😢 @Missingmydarling hey love, I take my Aspirin with my evening meal along with my prenatals xx

[Mizzy19]

@leah3 Had my midwife appointment today. Asked about Papp-a and she said it's not a huge concern and that it's a risk baby will be small but doesn't mean much especially if regular growth scans are booked and baby growth monitored. She didn't seem to be worried. Said heartbeat was good today.
My next scan is at week 21. In 5 weeks time, but she did say I could see her if I was concerned earlier or at week 24 for check.
All we can do is take aspirin in the evenings with meal and hope for the best.

[leah3]

@Mizzy19 ahh well that’s good! I didn’t get to hear baby’s heartbeat or anything :( seemed like to me, as nice as she was, she was just trying to hurry and get my appointment done. & exactly, yes 🙌🏾 I’ll probably book a private next week just to check baby girl is okay then I’ll wait for 20 week scan. Keep me posted on how u get on x

[CavernousScream]

I had low PAPP-A and ended up with HELLP syndrome and IUGR. I’d buy a home blood pressure monitor and keep an eye on it because it can develop very quickly. My experience was pretty scary and my daughter was v small when she was born (prematurely), but we are both absolutely fine now.

[Markryb]

It's exactly how our midwife reacted. But we got the letter for a growth scan with the PAPP-A results at 13 weeks. That was booked at 28 weeks. So we had our 20 week scan as normal aswel. We have our next scan at 32 weeks. So you might still receive a letter. From what I can gather all the trusts are completely different in how they handle it. Ours where we are don't do anything else other then growth scans and as long as the results are good then nothing happens. I have read other trusts will induce at 40 weeks either way. And some trusts won't even do growth scans.

[Mizzy19]

@leah3 i thought that's what they are meant to do, check heartbeat of baby at the midwife scans, otherwise what's the point of these appointments?
Last baby, I had it checked each time by the midwife at their appointments at Dr surgery. So unsure why they didn't check the little one's heartbeat today for you.
Because it's reassuring to know. But I'd book in privately for a check anyway if I were you. I got mine tomorrow, so will keep you posted.

[leah3]

@Mizzy19 ahhh I never knew that! I was literally in there 10 mins, she took a urine sample, wrote a few things in my maternity book then sent me on my way. I remember walking out of there thinking “well that was a bit pointless”. Oh wow, that’s so annoying!! I’ll look into that asap

& yes hun, please let me know how it goes x

[Nejnej2]

@leah3 @Mizzy19 I don't know about low PAPPA-A but my midwife told me that policy in my area (east Mids) is not to do Doppler for the heart beat until after 20 weeks as it can be hit and miss before, so often causes more stress.

[leah3]

@Nejnej2 thanks love. I’m based in East Mids so I guess that makes sense

[Mizzy19]

I'm in the West Mids. We've always had doppler for heartbeat from week 16 onwards.
I guess as @Nejnej2 says, each region is different. But I have to say, I was relieved today to hear a good heartbeat.
Plus each time, I've had midwife, there's always a student there learning, so I guess it helps them too.
We don't have maternity books, it's all on an online portal. Same with hospital. I guess that helps as we get to see the results online off any tests they do.

[Nejnej2]

@Mizzy19 God, I wish we had an online portal. My handheld notes are already looking slightly battered 🤦‍♀️

[Jemmac93]

Hi all, I'm in a similar situation! I recieved a letter saying my papp a was on the lower side and an appointment for a uterine artery scan booked in after my 20 week scan (I'm 15 weeks 2 days now). After searching loads I still dont really fully understand it, although what scares me most is that it CAN be linked to the 3 trisomies, although it doesnt mean it is the case for us obviously! But I'd already spoken to the screening midwife who told me not to worry as its actually quite common and 9 times out of 10 baby grows completely fine. I contacted her again hoping for reassurance that the link isnt supported by research but she said it is and the NHS will not offer me NIPT as I had a 1 in 4500 for downs and 1 in 2300 for Edward's and pataus syndrome. Now I am worried as I cannot afford the private NIPT screening - will my 20 week scan show up any anomalies in terms of downs or Edwards/Pataus? I'm so worried about my baby, my family had booked me a surprise private scan so they could come in to see baby and to tell the gender on saturday and now I'm just concerned they will tell me something is wrong, making it difficult to look forward too :( 12 week scan looked fine though so I'm taking some comfort in that. Thanks to anyone whose read this, it's just good to rant!

[Hoowhoowho]

Your 20 week scan will usually show up anomalies related to trisomies. I had low PaPP-A and the anomalies which culminated in a diagnosis of T18 for my daughter were detected at the 20 week scan, though we did have an excellent fetal medicine consultant.

Most low PappA isn’t caused by trisomies though. My risk of T18 was raised from age related risk at the 12 week scan and was in the hundreds rather than thousands and in hindsight there were several clues including my dates moving back at each scan.

If everything else looks good then low Papp-A is mostly an incidental finding.

[leah3]

@Jemmac93 awww bless u hun. Tbh if those were the results from your screening, your odds are massively in your favour, like massively!!! I’m no doctor at all but I’d say you should take a lot of reassurance from those results! 😀 I know the Papp-a thing is scary but it could just be normal for your pregnancy. I’ve just had a private scan done and baby girl is doing amazing (just under 16 weeks today). Did they prescribe you Aspirin for your low Papp-a?

[Jemmac93]

@leah3 yes been on 150mg in the evening for the last week as midwife said it helps reduce the risk of any growth problems for baby and also reduces any risk of pre eclampsia. Me and my partner decided as the screening said they didnt advise any further testing that we wouldnt pay for something we cant really afford when it also isnt able to give us a definitive answer for those things anyway and seeing as it is a very low risk but I cant help this low papp a thing being constantly in the back of my mind! It also cant tell me whether baby is growing properly or if my placenta is giving baby enough of what it needs so I will have to wait for the scan and artery doppler for those things. I know people tell you not to now but I have a fetal doppler from my first pregnancy with my daughter and the placenta sounds are consistent and strong as is babies heartbeat so thank God for that as I think I'd be going out of my mind with worry otherwise!

Thanks for responding!

[leah3]

@Jemmac93 i know exactly how you feel! It’s my first baby so I’m worrying about anything and everything. I’m just under 16 weeks and had 6 scans already! Trying to calm down now and only have routine ones going forward but baby seems to be doing great so far so hopefully that helps. Enjoy your pregnancy 🤍