Low PAPP-a, Nausea and tiredness, full time work

[Jasmine12]

Hi all,
I am 13 weeks preg (by LMP). Had a scan on thursday and was told that the baby is measuring ahead and the EDD was moved. That makes me 14 weeks today.

I am 33yrs old. NT scan last week measured Nuchal fold as 2.2mm, PAPP-a was 0.3MoM and HCG 1.27 MoM. Downs risk is 1:307. I am worried my placenta is not working/will not work properly (low PAPP-a)

I have bad nausea -throwing up after most meals. Looks like its getting worse in the last few days with horrible taste in my mouth all day :( Could this be becasue my placenta is not coping hence not taking over??

I am a freelance consultant (full time) - I work from my client's office. Its 1hr 15 mins commute - a 15 min bus ride, 45 min train, 10 min walk - I carry a laptop with me - a heavy bag is not helping esp with two flights of stairs at the station(s). I am finding it very difficult to manage/stay awake after the exhausting commute. Im falling behind on deadlines. if my client gets too pissed off with me, they will kick me out. They know I am pregnant, they are understanding, but they dont have to tolerate me. I am not a member of their staff. Luckily we are ok financially. I have some savings and can manage comfortably with DH's income. I plan quit in Dec (30 weeks then ) and be off for a year anyway. I am wondering if I am putting myself under too much pressure by not quitting now. I am not trying to be precious or something - I know a LOT of women work until 36 weeks. But I am really struggling to cope. What i'm worried about is this nausea/tiredness lifting after I quit and I dont know what to do with myself at home! We have a 6 yrs old DS, but he will be off to school from sept anyways.

I dont know what to do, low PAPP-a is worrying me, I am like a zombie - sleepy mind all the time, hating my commute to work, constant nausea - feeling miserable. This is a planned pregnancy - so I am feeling guilty about feeling awful.

Thank you for listening. Any advise is gratefully recieved !

I think you need to look at this as different problems. It sounds as though you are feeling very anxious about the low PAPP-a result and therefore are projecting this anxiety onto other pregnancy related symptoms.

First of all, call your midwife about the low PAPP-a and ask for an explanation. You are obviously concerned it is having an effect on you and need reassurance regarding that. I'm sure one of your community midwives would be more than happy to chat to you on the phone about it. In the meantime, step away from Google.

The nausea and vomiting is unfortunate - but some women do suffer all the way through pregnancy like that. For others it tails off at some point, and some lucky ones don't suffer at all! It doesn't necessarily mean anything is wrong. One of my friends is still vomiting daily at 35 weeks and is having a perfectly healthy pregnancy. Try to relax about it a little bit and make sure you are taking good care of yourself - vomiting and feeling nauseous is tiring and that won't be helping how you're feeling.

Finally, the tiredness. I've suffered really badly with tiredness all the way through my pregnancy. Up until around 22 weeks I felt as though I was barely surviving - like you, I have a long commute and a stressful job. Most days I was waking at 5:30am, on the train at 6:30am, leaving work at 6pm and going to bed by 8pm. I just had to find different strategies to make sure I was getting my work done. Can you nap on the train? Or take a slightly different combination of transport so it's quieter? Do you ask for a seat so you can rest? Are you prioritising your work accordingly to make sure you're hitting deadlines? I think it's important to try to persevere with work as much as possible - you have a lot of pregnancy ahead of you and you may need a reference or recommendation from this employer in the future. If you genuinely feel that you aren't coping, go and see your GP.

Hi I and similar results to you last pregnancy, with a Papp A of 0.29 and a HcG of 1.5. We had a private scan with Prof N at FMC who said about 10% of cases with such a low result have reduced growth.
was reassuring to be scanned by someone at the top of research.

All the best in what you decide to do.

I have low papp-a too so I know how worrying it is. What reassures me is knowing that it's a very small increase in chance of growth problems and doing all I can to help. So extra growth scans, taking baby aspirin and sleeping on my left side (a although more often than not I wake up on my back). So far no problems. I also take comfort in knowing that now it's been picked up I'm being monitored more closely.

Sickness and tiredness didn't ease off for me till about 16 weeks. One day I just woke up feeling 100 times better. I remember telling myself to just take one day at a time and not get too hung up on when it would end because I found myself really down that it hadn't disappeared at the magical 12 week mark.

Good luck with the rest of your pregnancy

Thanks everyone for your support.

DefinitelyNotElsa: Its probably the Papp-a thing thats worrying me the most. I had a bad cold last week and I HAD TO be in office for something. It didnt help. I feel better now.

RooibosTeaAgain: Thank you for sharing your experience. Its very reassuring.

NewMrsX : What is baby asprin?

April2013: Yep- there is a lot of pressure to carry on as normal. Men think we just grow a tummy and a baby pops out! we grow a tummy like their beer bellies! I have morons at work who think like this.

I dont have to be in office for my work. Its just the client's work culture. Some of client's own staff are home based but they have a problem with a "consultant" working from home. My boss actually told me "12 weeks - too early isnt it?" - too early for what? Being knackered by the long commute? Being tired? For nausea? They pay me for my work - for my deliverables. I can do it comfortably within deadlines if they let me work from home for a few days.Anyway, I agreed to these terms by being a freelance consultant. They pay me a lot more that what they pay their own staff - so they perhaps feel justified in making me work harder for my money. I wish they realised how counter productive it is - to get me to warm my chair in office when I can be more productive when I work from home.

I've decided to give myself 3-4 weeks to see how I am coping. If I feel I am really really hating all this, I will hand in my notice.

Agree with what others have said - talk to your mw about the low Papp-A and what can/should be done regarding follow up. Alternatively, call your antenatal clinic at the hospital, did they discuss with you that you might go under consultant-led care.

Baby aspirin is low-dose aspirin (75mg tablets).

I would try and re-negotiate the working from home with your employer - maybe on a temporary basis for 3-4 weeks, to see how you feel then? The nausea/tiredness might well be gone by then. It would be in their best interest, too, as obviously, you'd be more able to deliver the results they want! Sorry that your boss is such an idiot, it really doesn't help.
I'm just wondering if you are actually working on their premises, if they would not have to do the usual H&S assessments etc that are required for pg women...? Is there anyone you could ask, maybe their HR?

Hope it'll all improve soon x

I also pushed for repeat growth scans and dopplers due to low Papp a. Optimally should be 3 weekly but we got 4 weekly agreed. Also started taking low dose aspirin. This needs to be started before 16 weeks ideally so might be worth asking your midwife now.

I am now 33 weeks, the low Papp a for us was due to trisomy 18 but despite both dopplers and growth are still normal. I think it was the aspirin.

I doubt the nausea is linked at all unless made worse by anxiety.

Yes low dose aspirin is what I take in my pregnancies for low Papp A.

As pp have pointed out its low dose Aspirin, you can buy it in the supermarket. No one mentioned it to me though and I only found out about it when reading up about low Papp-a online so I asked the midwife. She rang the consultant who performed my cvs and he said I could take it if I wanted and it was safe but it's not currently policy to recommend it in my area but probably will be in a few years. You have to stop taking it around 36 weeks though otherwise it might increase your chances of bleeding after labour. Hth