Low Papp A and aspirin - help!

[Seahawk80]

I know I should ask my doctor / midwife rather than the Internet and I am trying. I'm just really stuck. Also sorry for the long post - didn't want to drip feed!

I had my 12 week scan in December and came back with high odds for all 3 trisonomies. Everything was fine but one of the reasons for the results was that my Papp A was low (0.28). They said I would have extra growth scans and that was it. I didn't get any extra advice or appointments sat the time. I am at Kings College Hospital London.I also had the harmony test at FMC which is linked to Kings. They recommended that I take low dose aspirin daily. I started taking it but then had some bleeding and stopped as I wanted to double check what to do with Kings. My midwife said she wasn't sure and that I should check at my 20 week scan which I did. The Dr that did it was very odd, he said he'd check and call me, but of course he didn't. I've now asked my midwife again and she's made me a consultant appointment but it's not for over 3 weeks. She said I can call the specialist midwives but I can never get through. I'll keep trying but it's difficult at work.

My question is has anyone with low Papp A not been advised to take aspirin? I'm worried about going another month without taking it when I should be. I'm considering booking a private consultant appointment which I can't really afford but it's just proving impossible to get an answer from the NHS. Every post I've read about Papp A says they were advised to take low dose aspirin so I'd be interested to hear other people's experiences. Thanks.

From what I understand the advice on low dose aspirin for low PAPP A is mixed and certainly my consultants did not advise for my first two low PAPP A pregnancies (0.1 and 0.3 MOM respectively). I'm currently on my third (low PAPP A pregnancy 0.3 MOM) and I paid privately to have the Harmony test at the FMC where, like you, I was advised to take low dose aspirin. When I asked my Consultant he kind of grudgingly agreed. I've done as much digging on low PAPP A as I can and although it can indicate either chromosomal abnormalities or placental issues it can also mean neither. Whilst my first pregnancy was IUGR resulting in a very small prem) now 5 and absolutely fine. My second was completely straightforward. I have had regular growth scans with all three and am currently 28 weeks with no indication of any issues at this stage (by which my first had fallen off the growth charts and I was having twice weekly scans). I hope I haven't alarmed you, I guess what I am trying to say that fingers crossed you will be absolutely fine. Feel free to PM me if you have any questions. When is your next appointment? It's pretty rubbish you haven't had the promised advice on whether you should be taking aspirin.

Thanks, that's really helpful, and so kind of you. I wish now I'd pushed for a consultant appointment earlier but I think I was just trusting the system too much and assuming that they would tell me if I needed to do anything. I'm 25 weeks now and have a scan at 28 weeks then the consultant appointment the day after which I guess is quite good as we'll know exactly where the baby is growth wise. I've been worrying that it's another month without taking aspirin if I should be but I'll keep trying the specialist midwives to see what they say. I did consider going private but I think by the time I set up an appointment it will probably only be a week or so before the NHS one.Everything so far has been totally fine with the baby at the scans so at least that is reassuring. My last scan was at 20 weeks though so it is a bit of a gap.

Congratulations on your 3rd!

Hi both - I don't have much to add here, but it's nice to find other people with low PAPP-A. I found out a couple of weeks ago via a letter and haven't seen/spoken to any medical people since, but my next midwife appointment is on Monday and I plan to ask about taking aspirin, so I'll let you know the outcome.

My letter didn't say anything about consultant referrals - just an extra scan at 34 weeks, or sooner if my bump measurements are low. However, I'd already been referred to a consultant for a different matter (not had the appointment yet) so I don't know if this will be discussed then.

I'm 37 weeks and had low PAPPa (combined results were 1:85 and CVS came back clear). I wasn't advised to take anything at all and I'm at FMC at Kings. Have a growth scan next week which is standard at Kings anyway. Baby is growing as they should at each midwife appointment too 😊

Thanks duck - let me know how you get on. It's scary isn't it. It's weird that they test for it but then no one can tell you what the results really mean.

Hi sarah I remember chatting when I was waiting for my cvs results. You're nearly there now! Hope it all goes well.

Yes! Although DH said that if they thought it was really a problem, they would have told me by phone or face-to-face rather than via a letter, so he takes that to mean they're not too concerned. Seems to be more of a wait-and-see situation though - sometimes it causes problems, sometimes it doesn't. Sarah, thanks for sharing your story - glad things have gone smoothly for you!

Hello I've been taking aspirin for the past 4 weeks. I got a phone call the week after my 12 week scan saying that I needed to go in to see the screening coordinator.
Low risk for Edwards & downs but my Pappa was 0.39 so 0.03 below the cut off. I've been prescribed aspirin daily until delivery and was told at my hospital of 300 women who were started on the aspirin because of high risk of blood pressure all 300 didn't develop the high blood pressure.
My midwife also didn't seem concerned so I'm going with what my dr says

That's interesting dixie. I didn't actually know the aspirin was for high blood pressure. That makes me feel better as mine is always ridiculously low. I know that can all change with pregnancy but if the aspirin is to prevent high blood pressure rather than issues with the placenta that makes me more relaxed about not taking it if that makes sense.

I was also told it stops the thinner vessels on the placenta which usually clot and fall off at16 weeks from clotting. Therefore baby is getting more nutrients from the placenta.
My dr told me main two things for me for low pappa was high blood pressure in later pregnancy & a smaller baby. So I'll be having extra growth scans at 32&38 and potentially 34&36

That's good that it was explained to you dixie . I have a growth scan at 28 weeks and my consultant appt the day after so I hope I'll feel much better after that!

I had low papp-a with my first pregnancy, I had consultant appointments and scans every 3-4 weeks from 24 weeks onwards. My consultant and midwife weren't too concerned about low papp-a, it seems to lack evidence but they said they'd rather be over cautious with it all. I took low dose asprin but I did stop taking it during my pregnancy due to a mix up and my doctors refusing to prescribe it and it didn't seem to affect anything. One thing I can say is remember growth scans are just an estimate, my dcs growth was fine throughout then I got scanned at 39 weeks and he hadn't grew since the previous scan 4 wreks earlier and I seriously panicked. I got induced the next day due to different reasons and he came out 3lb heavier than they estimated the day before 🙈

Update as promised - I asked the midwife about taking aspirin and she said it wasn't necessary. She said my iron levels were good, therefore not too concerned about my low PAPP-A at the moment (had no idea it had anything to do with iron!) My blood pressure is healthy at the moment too, so all good.

Hi OP, I had very low PAPP-A with my first pregnancy and it was 0.09mom. I was not prescribed aspirin. I was monitored with growth scans and traces in the 3rd trimester to check placental and cord function and everything was fine. I was induced early and my son was healthy, though on the smaller side 2.6kg.

Hope all goes well for you

Thanks everyone, that's really helpful and reassuring, makes me feel much better. Good luck to everyone.

@imsodizzy I know what you mean about the growth scans. My sister (who has other health problems) had a c section at 37 weeks due to her very large baby, baby was under 8lb!

Hi ladies,

It's positive reading your posts. I have been classed as high risk of downs etc but I think mainly because my papp-a is 0.26. I have a cvs booked for Tuesday. But I am laying in bed now worrying I don't actually feel pregnant. This is my second pregnancy and I am not as sick as I was. I wonder if this has anything to do with the low papp-a levels?

I'm on Aspirin due to low PAPP-A and was told it's because it's an indicator that I might be at risk of developing pre-eclampsia/high blood pressure.

The aspirin thins the blood so blood and the nutrients it carries pass easier though the placenta to baby meaning baby is at less risk of being small too

I would much rather take it just in case...as I can't see how it could cause harm. The dose they prescribe is that meant for a child which I find reassuring!

Hi I have been told I have low papp-a on the phone and the information they have given me was not so much just oh hi you have low papp-a please pick up aspirin it's ridiculous I'm in shock I wasn't even told how low or anything

Hi,

I have just today had the same call and to take aspirin once my prescription comes through.

Do you have any updates??

Hi,
I know this isnt a new post but i found out today i have low papa a. Im 12 weeks. Now im really concerned. How did everything turn out for you all? Did you all carry to term? Im really concerned about delievering way to early

Hi - I just got a notification about this because I commented on the thread years ago.
I had extra scans at 30 and 36 weeks - at 36 weeks my LB wa estimated at weighing 6lb 3os and I was told to stop taking the aspirin.
My little boy was born at 38 weeks weighing 6lb 10oz and perfectly healthy (I’m only 5ft 1 so wasn’t expecting a giant baby anyway!) and other than a traumatic delivery I suffered nothing related to high blood pressure.

@Moniquej

Hi, I know this isnt a new post but i found out today i have low papa a. Im 12 weeks. Now im really concerned. How did everything turn out for you all? Did you all carry to term? Im really concerned about delievering way to early

Im not one of the original posters but I’m 30 weeks and just had my first growth scan today because of low PAPPA. The baby is measuring above average (around 85th for head and abdominal) so just because there are increased risks of a small baby etc it doesn’t mean it will definitely be the case. Try not to worry - easier said than done I know.

@Moniquej

Hi,
How are you getting on? I just found your post. I also got a low Pappa result from my 13 weeks scan, mine is at 0.36
How is it all going, what are the doctors saying? Mine did not really comment on it at all ...

Hi,

I am currently 22 weeks now and so far everything is going well. We had out 20 week scan 2 weeks ago and baby is healthy and everything looks as it should. I have 3 more growth scans booked in for the remainder of my pregnancy to track the growth, so far ive had no issues from it. I have been taking low dose aspirin every night which i was told boosts the placenta to 95%. For me it means i need extra scans and appointments so they can keep a close eye on it

@Moniquej

It’s great that all is going well, fingers crossed it will all be good. I am absolutely petrified about all of this stuff... do you remember what your result was? Also, what is your doctor say about all of it?

I cant remember what my result was just that it was low. Doctors arent saying anything as it isnt presenting an issue, baby is healthy and moving around, so far all is well. I was told not to stress to much about it