Low PAPP.A & Aspirin in pregnancy?

[Mrsmujic]

So I know there is a section on MN for antenatal tests but it doesn't seem to be used much so seeking any similar cases here.

I got my 12 wk tests back earlier this week and was told I have low papp.a and I should now take aspirin for the rest of pregnancy. Has anyone else had to do this?

Everything just feels a bit scary as I was also told I have 1:23 risk of downs syndrome but trying to just wait for the other bloods to come back before I have a melt down over it!

Any similar experiences would be helpful right now X

I actually would not worry with what they said based on 1 test result. What was your NT and Papp-a and HCG?

The initial NHS bloods skew the probability towards the worst case scenario. Ask for NIPT, which is far more sensitive and accurate.

Low Papp-a can also put you at higher risk of IUGR and preeclampsia, although many people have low Papp-a without those issues. The aspirin if just to help the blood flow to the placenta and lower the chance of those issues developing. My Papp-a was fine but I have high blood pressure so take aspirin to help with the blood flow.

@Helpdesk3
They took bloods straight away for NIPT when I went in to discuss options. I think HCG was just above 1? (Can't remember) NT was 1.4 and PAPP.A was extremely low at 0.16 which is pretty scary! X

I’m on aspirin for low Papp-A and so far touch wood the baby is growing well with no problems relating to the Papp-a.

I can’t advise on your other tests, but I hope all goes smoothly!

I've got Low PAPP-A as well and am on aspirin.which I was told is to prevent pre eclampsia because it's an indicator you may be higher risk but then again you may not be but they play it on the safe side all the same. Go to the Low PAPP-A support group on Facebook it will put your mind at ease and you can speak to lots of others in the same situation. From what I've learnt in that group the level of your PAPP-A often doesn't mean anything. It's just an indicator and there's some research about it which just means they keep their eye on you which is good. It doesn't affect most women and if it does they'll keep an eye on your baby's growth and make sure everything is progressing ok.

I had very similar results to you which were cleared up by the NIPT test. The wait is horrible but I hope you manage to relax a bit (I didn't though).

Advice to take aspirin seems to vary, I asked specifically and was told they don't recommend it in my health board.

It's worth visiting the antenatal tests forums again, there's quite a few topics about this this and one with a lot of comments which really helped me when I was in the same place as you (called something like "normal Nt..."

I also had similar results (Nt 2.7, papp a 0.22 and hcg 1.04) this gave me a 1 in 5 chance of Downs. The wait for the nipt was awful, I hope it passes for you quickly! My hospital also don't recommend asprin, no idea why not as most seem to!

Thanks all! Yeah I'm trying to just remain positive and hope for the best. The pharmacist didnt seem too keen to give me the prescription of aspirin.. she wants to call me in a week and check im okay!

The wait for these results is awful but thankfully it's available on the NHS and we have the science to check these things.

Xx

Little update from me, my results came back as low risk. What a relief! Hope all of you are all good xx

Same here - taking aspirin for low papp a but all of my screenings came back as normal or low risk. I’ve got three extra growth scans - 28 weeks, 32 and like 40 weeks I think. There isn’t a lot of evidence around the low papp a thing - my consultant said they treat everyone the same (aspirin/scans) but most women don’t end up having small or premature babies x

Hi @Mrsmujic I am a bit late to the post but after I received results of 0.38 low PAPP-A I have been researching like mad. Everything else normal.. very worrying xx

Hi @champersandchocolate

Thats exactly the same number as my recent 12w bloods (currently 14w) ! Like you everything else normal and low risk. I got a letter but have yet to discuss with my midwife. I have been prescribed 150mg aspirin every evening and have had appointments through for extra scans in later stages. How about with you?

I also did a lot of research which reflected some of the above. Lots of countries and some trusts don't test for Papp A as they don't see it as a stand alone risk factor. Also some trusts which do consider below 0.3 or 0.4 to be 'low' where mine is 0.5 making the 'deficiency' seem more extreme.

Hope you're doing OK and it's not stressed you out too badly x

Overall I'm trying not to worry and be grateful for extra scans etc. It's given me a bit of a wake up call to make good choices about diet and exercise in the 2nd trimester as while you can't affect Papp A you can do things to generally benefit your placenta which will make me feel more positive.

@JuneySunshine Hey, good to know I'm not the only one. I have been prescribed 150mg of Aspirin - it seems such a high dosage as people with what I feel, more complicated problems only get 75mg. But then, the risk of the placenta packing in is of course a huge problem so perhaps that's why it's the full 150mg - who knows? The NHS don't give any clarification.

I have asked for the PAPP-A to be tested again, to get an average reading they should dip in the blood at least 3 times, do they do that? How do we know? I'm speaking with my Private Fetal Medicine doctor tomorrow, I have chosen to spend the money on her this time as a Fetal Anomaly ended my last pregnancy in the second trimester and it was awful.

I have extra scans but only from 32 weeks.
I am doing all I can to eat healthy but suffering from sickness at the same time so a little tricky. My current school run is a 4 mile hilly walk every day so that is my exercise (unless it's raining!). 😂

I sound like I'm in denial, a bit, but I'm just so concerned. Hopefully tomorrow I can get more clarification, good to know in some countries, stand alone low PAPP-A isn't considered as abnormal they make it seem here.

Hi girls, yeah I was really worried when I first found out, but you know what, I think stress and worry will have more affect on the baby to be honest so I'm relaxed. I'm 18 weeks now, I saw the midwife last week who is happy with everything, listened to baby's heart too which is perfectly fine. There is a slight risk of early or underweight baby's from what I've researched but I've spoken to a lot of people who go on the have healthy pregnancy and babies! I'm also on the higher does of aspirin but I think it's more precaution just in case.

Don't over Google as the bad stuff sticks out more than the good. Trust your midwife as I think they know best if all is okay 😊

Thanks for the update @Mrsmujic , lovely to hear that from someone a month further down the line :) like you form what I've seen the vast majority don't seem to see any effect.

@Champersandchocolate Sorry to hear about your previous loss, that must make this doubly worrying. I think speaking to a specialist sounds great. I did wonder that about the blood test too, and also if they'll be repeated at a later date to see whether we can move out of this category or if it's fixed for the whole pregnancy now. I'm hoping a word with the midwife will help.

I know what you mean about the diet. I've had sickness had aversions to things I should be eating (eggs, greens) but I've just had to bite the bullet and cook them (which seems to be the worst bit!) then take a break and eat. I don't want some mega-diet just to get back to the range I had pre-pregnancy. Let us know how you get on x

Hello, hope all is well with everyone, would love to hear your updates.

Just popping back to see if anyone can shed light on upcoming appointments. I have;

A consultant appointment (a.m.) and 20 week scan (p.m) at 20w+1
A consultant appointment at 22w

The second consultant appointment had an attachment with info about Uterine Artery Doppler so I'm assuming that's the purpose of that one. I just wondered if anyone had thought as to what the first one might be for?
Partly so I can prepare myself, partly as we need to decide if my partner comes to one or both appointments at 20w+1 and I don't want to get him there for both if it's just some background chat/ routine stuff.

Tia

I had consultant at 19 weeks and it was just a chat to go over why I was high risk etc
After 20 weeks I had a cord flow scan but they said it was hit and miss and as a trust they have only just started doing them again, they got the measurements or whatever they needed fine on one side but couldn’t on the other. I’ve had further growth scans at 28 and 32 weeks (had one today)
All of my measurements and fluid levels and cord flow readings have all been fine and what would be expected for her age. As of today she is 4lb 9oz so hopefully we have not been affected by the potential growth restriction/low birth weight as some people get with the low papp a
I have another consultant app at 36 weeks - not sure if it’s just talking or if there will be a scan. I have a final growth scan booked at 40 weeks but I am hopeful she will be here by then!

Hi @Ameteurmum thank you so much for replying. Absolutely delighted to hear everything is progressing well with you and your little one.

In that case I think I'm going to just expect a conversation for the first appointment and the cord scan at the second. It might be a short conversation tbh as the only risk I know of with me is the low Papp A, but still I'm grateful for the extra care.

@JuneySunshine - I felt just the same, glad of any extra attention! It seems to be something relatively new they are testing for so any information about it seems to be like gold dust! X

I took aspirin for low Papp-a. Had an IUGR baby and pre eclampsia first time round. Second baby was growing well but then arrived of her own accord at 28 weeks.

Hello,

Just popping back to this thread to update for those on it or for anyone scouring mumsnet in future.

I'm now 36 weeks having had a normal 20 week scan, bump measurements on the 60th percentile consistently and a latest growth scan putting baby on the 70th percentile at 6lb and 8oz. There's been no further issues i.e. doppler was good, no signs of pre-eclampsia etc etc.

Despite all this after my scan today I saw the consultant who said they'd suggest another scan at 39 weeks, 2 sweeps at 39 weeks and induction on my due date owing to Low Papp A.

Tbh I'm a little surprised that given none of the risks seem to have materialised they are still recommending different treatment to a normal low risk birth and I'm going to be having a think about induction timing and discussion with my midwife.

Has anyone else got experience of this to share?

@JuneySunshine and @Mrsmujic I'm in a similar situation have very low PAPP-A and am currently 18 weeks and wondering what's ahead of me. How did you both get on?

Hi @Mumblingmum hope you're doing OK. Just to add to the above update then.

I was getting myself in a bit of a stress because the low Papp A meant my pregancy was labelled as 'high-risk' although, other than the blood test at 12 weeks there was nothing to justify that. Mainly I was concerned about what it meant for my birth plan- birth centre vs delivery suite etc. etc. I expressed this to my midwife who said really I'd need to speak to my consultant if I wanted to change that- but it all became irrelevant!

I went back for my 39 week scan at 39 +1 at which point they said fetal growth had dipped slightly as had blood flow through the cord. Long story short, I didn't go home from the scan! I had a pessary followed by a very rapid labour with no further intervention in the delivry suite. Little girl born on 39w+2, 6lb 8oz, all healthy, and now a beautiful 10mo.

Looking back now I still feel that I don't know what/ if there was any impact of the Low PappA. I feel that it got me some extra scans and monitoring (good) but also put me on the radar for induction in what is a very induction-happy NHS Trust according to the statistics (bad).

For you I think you just need to think of the low PappA as not being a problem until there is proper evidence there is a problem- if that makes sense. You can worry your whole pregnancy and like me, never really know if there was any impact.

I think someone has already mentioned but this group is really helpful www.facebook.com/groups/129843767631323 and please feel free to DM me. Best of luck with it all 💐x

Hi @JuneySunshine
Thank you so much for coming back to me. I've already had one daughter who was perfectly healthy and 2 weeks late without low papp-a followed my a late miscarriage which did have low papp-a, so hence I'm slightly worried! But thank you for that, that's given me some reassurance.
It's nice that they give you extra scans like you said, but yes i really wanted to try and avoid an induction this time as I had one with my daughter and had a horrendous birth following that. I guess so long as baby is healthy that's the main thing.
Thats a good point to think of it not as a problem unless there is evidence- thank you.
Thanks again for replying, I hope I get on as far on as you did and everything is also healthy😊

Hello, another update for anyone searching for Low PAPP A experiences.

I was posting on the thread about my low PAPPA (0.38) pregnancy with my little girl in 2022. Born healthy, 39+2 and 6lb 8.

I'm pregnant again now. I've had my 12w screening and PAPP A is in the normal range at 1.1 this time- so that's one less thing to worry about. I think I saw a study which said in a group of women who had Low PAPP A with their first pregnancy 70-something % didn't with their second, so while the chance is higher than the 5% for the general population its not wildy high.

Anyway, hope it might help someone to read this.