Low PAPP-A

[RosieRabbit17]

We received our 12 week screening results on Wednesday and although they weren't high risk, I was surprised that the numbers were a lot lower than in my last pregnancy.

Downs: 1 in 258
Edwards and Pateaus: 1 in 400 and something

In my last pregnancy, these numbers were something crazy in the thousands.

As it said low risk, I stopped worrying think it was probably because I was older this time and overweight, where as I wasn't last time.

But then last night we got a letter saying that the screening had also shown low PAPP-A and that I should start taking a daily dose of 150mg aspirin and that I'd need growth scans in the 3rd trimester. I don't know what the exact level is as the box is just ticked that said less than 0.4 MOM.

I'm just wondering if anyone has had low PAPP-A before and what the outcome was? Did you become high risk? Did you have a small baby? Did you go into labour early?

My last baby was smallish (6ib 13) but I'm only 5 foot so I just assumed I'd have small babies anyway. I'm worried that this one will be naturally small and they'll end up worrying about growth etc.

Just can't help worrying as it's so different from my last pregnancy!

Just bumping this up as I can't see it anywhere now.

I am 17 weeks pregnant and my Papp-a is low at 0.31, I didn't know the numbers until the consultant called me.
I am on daily aspirin and will need extra growth scans later on in pregnancy.

Haven't had it before to know they effects etc but there's a low Papp-a Facebook group them at I've found very useful.

My other children were 6lb 9 & 7lb 3, in only 5ft so never destined to have big babies lol x

@crobo87

I am 17 weeks pregnant and my Papp-a is low at 0.31, I didn't know the numbers until the consultant called me. I am on daily aspirin and will need extra growth scans later on in pregnancy.

Haven't had it before to know they effects etc but there's a low Papp-a Facebook group them at I've found very useful.

My other children were 6lb 9 & 7lb 3, in only 5ft so never destined to have big babies lol x

Thanks for your reply. I'm 5 ft too so expecting another small baby anyway 🤣

I spoke to the midwife this afternoon who told me my levels are 0.21 so are particularly low but she didn't seem too overly worried about it just said that I eight have to be induce early and certainly by 40 weeks so feeling a bit better about it all now.

For some reason, I cannot find the Facebook group you mentioned!

It's called low Papp-a pregnancy support group x

Hi @RosieRabbit17
Exactly the same for me! Was so worried when I got the letter. Mines 0.41 I think.

I had my daughter 3 years ago and midwife said this PappA test is relatively new. She didn't seem overly concerned tho at all! Just said extra monitoring and to take the aspirin. My daughter was 2 weeks early and only 6lbs so maybe I had then?

How far along are you? Xx

I'm 32 weeks with low PAPP-A. I've had one extra growth scan so far and the baby is measuring in the 80th percentile, so bigger than average. I had a call from a consultant today as a standard follow up who said I won't need their involvement and that it's not unusual for it not to result in a small baby. It's just an indicator that it could.

I had low Papp-a in my first pregnancy and from mine and other people's experiences, the aspirin and growth scans seem like a 'just in case' type of precaution. I think luckily most people seem to have no complications from it and they just keep a slightly closer eye on you.

Did also get induced at 40+5 just to be safe and all was fine and she was 7 pounds 10. Hopefully it all goes smoothly for you

@xem87

Hi *@RosieRabbit17* Exactly the same for me! Was so worried when I got the letter. Mines 0.41 I think.

I had my daughter 3 years ago and midwife said this PappA test is relatively new. She didn't seem overly concerned tho at all! Just said extra monitoring and to take the aspirin. My daughter was 2 weeks early and only 6lbs so maybe I had then?

How far along are you? Xx

Yes to be fair my midwife didn't seem to overly worried about the here and now just at the end.

I'm 14 weeks now. How far along are you

See your result is just below the cut off for concern. I haven't managed to find anybody who has had a result as low as mine which makes me worry.

@MimiDaisy11

I'm 32 weeks with low PAPP-A. I've had one extra growth scan so far and the baby is measuring in the 80th percentile, so bigger than average. I had a call from a consultant today as a standard follow up who said I won't need their involvement and that it's not unusual for it not to result in a small baby. It's just an indicator that it could.

Thank you for sharing your experience My first son was only 6 13 and he was over due so I doubt this one will be as healthy a weight as yours! But it's nice to hear a positive outcome. Can I ask what level of PAPP-A you had?

@Choclover89

I had low Papp-a in my first pregnancy and from mine and other people's experiences, the aspirin and growth scans seem like a 'just in case' type of precaution. I think luckily most people seem to have no complications from it and they just keep a slightly closer eye on you.

Did also get induced at 40+5 just to be safe and all was fine and she was 7 pounds 10. Hopefully it all goes smoothly for you

Do you recall what your level was at all?

Again, thanks for sharing a positive story, it's nice to her some positive outcomes. My midwife has already said that they won't let me go overdue so also looking at another induction which I wanted to avoid this time but there you go!

I had low papp a, can't remember the number. It meant I had 2 extra planned scans, and I had another at 39 weeks too.

I was induced, which went fine. Dd arrived quickly which is common after 1st pregnancy.

I had low PappA (0.17 MoM I think). No problems through most of pregnancy (I took aspirin up to about 36-37 weeks as the advice then was that you needed to stop before birth). I don't want to worry you but one of the risks that it's worth being extra vigilant about is pre-eclampsia, which I developed at 38.6.

It's hard to tell if DS was growth restricted - he was 6lb 2 when he was born at 39 weeks, which is between 2nd and 9th centile. I'm 5'1 so this could be related to my height (though my husband is over 6 feet tall). Anyway all well now, he's a healthy 6 year old creeping up to 25th centile!

I think mine was 0.36 last time and because I had high HCG we got a result of 1:90 chance of down syndrome (which she doesn't have). In the end my pregnant friends were actually jealous because I got more scan opportunities

@UnaOfStormhold

I had low PappA (0.17 MoM I think). No problems through most of pregnancy (I took aspirin up to about 36-37 weeks as the advice then was that you needed to stop before birth). I don't want to worry you but one of the risks that it's worth being extra vigilant about is pre-eclampsia, which I developed at 38.6.

It's hard to tell if DS was growth restricted - he was 6lb 2 when he was born at 39 weeks, which is between 2nd and 9th centile. I'm 5'1 so this could be related to my height (though my husband is over 6 feet tall). Anyway all well now, he's a healthy 6 year old creeping up to 25th centile!

Thank you this is actually really great to read because everyone else I've come across has been just under the threshold where as your result is more like mine. I'm also tiny - only 5 foot and my hubby is definitely not as tall as yours so I would be amazed if we had a big baby anyway! I've been worrying that I wouldn't even make it to the 20 week scan with such a low level so this has really helped to reassure me 😊

I am a bit worried about blood pressure. Mine has already been a little on the high side already but I suppose I'll have to see how it goes.

@Choclover89

I think mine was 0.36 last time and because I had high HCG we got a result of 1:90 chance of down syndrome (which she doesn't have). In the end my pregnant friends were actually jealous because I got more scan opportunities

To be fair, I am quite happy about the extra scans - at least that's one benefit!

Can I ask what level of PAPP-A you had?

I think it's somewhere between 0.24 - 0.26

Mine was I believe extremely low (0.3). I had lots of scans and consultant appointments. Which actually I was really grateful for as I got to see baby lots and I was being closely monitored. Baby was measuring small throughout the 2nd trimester and the plan was to induce at 38 weeks. He’s growth started slowing down at 35 weeks. So instead I was induced just on 36 weeks. He was fairly small at 4 pound 11 but was very healthy and we left the hospital the next day. Never had any health issues and he’s now 3! Also is bigger than most of his peers .

I think I’m the rare exception as my friend who also had low Papp A was induced at 38 weeks and baby was average size. So please don’t worry! You’ll have lots of care and support.

Hi, I just wanted to join. I am 14 weeks +1 and just got my screening letter. I'm low risk for everything. But have low Papp-a of 0.3. I rang the screening midwife who calmed me down. But I'm getting myself worked up again. Worrying that what if the placenta isn't working properly? It's reassuring to hear your positive experiences with this. This is my second child. 4th pregnancy with 2 missed miscarriages in the first trimester. They have said I'd normally get growth scans but because of the pandemic I'll only get 1 growth scan at 36 weeks. I'm really concerned about that.

@Pancakes7

Hi, I just wanted to join. I am 14 weeks +1 and just got my screening letter. I'm low risk for everything. But have low Papp-a of 0.3. I rang the screening midwife who calmed me down. But I'm getting myself worked up again. Worrying that what if the placenta isn't working properly? It's reassuring to hear your positive experiences with this. This is my second child. 4th pregnancy with 2 missed miscarriages in the first trimester. They have said I'd normally get growth scans but because of the pandemic I'll only get 1 growth scan at 36 weeks. I'm really concerned about that.

That doesn't sound right! I've been told I'll have 3 growth scans. I would definitely question that m. Reading so many positive stories has definitely made me feel better but I am still worried about it and I am almost dreading my 20 week scan because it seems really scary!

Hi Pancakes,

Congratulations on your pregnancy! I remember going crazy after finding out about the low PAPP A and Googling constantly. I wish I didn’t because it took away the enjoyment of the pregnancy. Please don’t it will only add more stress.

In terms of only being offered 1 growth scan at 36 weeks. I’m really shocked and appalled by this. Are you under consultant care? I believe I had a scan 1x every 4-6weeks after my 20 week scan. I also think general guidelines is for a Doppler scan at 28 weeks. In between this was seeing the midwife every week or fortnight. I know a lot has changed since Covid but I don’t think that’s a good enough reason to offer one additional scan. I believe some hospitals will scan every 3 weeks.

@RosieRabbit17 , @Mamathebest

I've been referred to a consultant already which I think is because I had a planned c section in my previous pregnancy because DS was extended breech. It's not for 2 weeks though and is over the phone. I will mention this Papp-a result though as I'm really worried and I don't think it's fair to not have the growth scans simply because of the pandemic. My friend just had her baby and had growth scans every 2 weeks because her DS was under the tenth centile. The same hospital! I've emailed a message to my midwife too asking if I should be taking aspirin. I just feel like how will I enjoy this pregnancy now? Sorry just don't know what to think.

@Pancakes7

I hope I haven’t said anything to worry you. It’s actually positive that you haven’t spoken to your consultant yet. I assumed this is what the consultant stated. As ultimately it is the consultants decision to offer extra scans and create a plan for you moving forward. You can speak to the consultant about your concerns and make it clear that you would feel it would be against general medical advice to not offer extra scans and appointments.

Have you begun taking aspirin?

A nurse that I spoke to when I got my initial results said that PAPP-A is a very new thing they have started testing for. They aren’t really sure yet to what it means. And I remember her saying that for many women who have low PAPP A, they have fairly normal pregnancies. Even if baby is growing smaller than expected (which is fairly common!) they will be quick to reassess your situation and respond accordingly.

Also generally growth issues become more easier to spot later (20th week onwards) then now. So at the moment keep doing what your doing and wait to have a (hopefully!) positive chat with your consultant. I hope you have a lovely and easy pregnancy

Apologies @Pancakes7 I missed what you said about Asprin. Normally after the results are given the midwife I believe should have offered you a low dose of asprin. It’s great you’ve emailed to clarify.

I got a call after my 12 week scan letting me know to start taking aspirin because of low Papp-A but no further details!

I’m 16 weeks now, with a midwife appt next week so I’ll be asking for more info on what will happen for the rest of the pregnancy.

Consultant care/extra scans etc. Haven’t been mentioned to me at all!

My midwife is really nice but not the most organised. At my last appointment, she casually said something like "Oh, I probably should have had you on aspirin but there's no point now". So, yes if you're not on aspirin I'd advise asking just to make sure.

One scan at 36 weeks does seem a bit rubbish especially if it's due to the pandemic. It would surely make more sense to have it earlier at 26 or 30 weeks so you could see what the growth was looking like and then book in more if needed. I imagine though if your 20-week scan and bump measurements are lower than average they'll add in more scans.

Try not to worry though as lots of women have low papp-a and it doesn't affect their births.