Low Papp-A ? NIPT?

[SaraKitty]

Hi All , with my second baby I had a normal 12wk scan but my blood test showed a low Papp-A hormone and as a result I was considered high(er) risk for foetal abnormalities . Cue a panicked call from my midwife whilst I was on holidays . She advices two options - NIPT test or wait a few weeks and have the probe procedure (can’t remember the name ). I paid privately for harmony test and had an agonising wait for the results which were all good thankfully .
I still had to have extra growth scans for the Papp-A and they were even recommending induction around 40wks even if growth scans were ok . It’s because low Papp-a can cause placenta issues in late pregnancy . There were absolutely no red flags on my scan and I had an elective section for non medical reasons.
Now this time around I am considering just getting NIPT upfront to prevent all the potential stress. Has anyone else had low Papp-A? I didn’t have any issues with it in my first pregnancy . I’m also thinking as I had my 2nd jab on ovulation day it would be nice to have the NIPT for peace of mind too but 300 quid .

Low Papp-A alone is not an indicator for fetal abnormalities, if your screening test came back high chance for a chromosomal issue in your first pregnancy that’s why they would have advised NIPT or amniocentesis. But that would have been influenced by a few other factors within the screening report test definitely not just a low Papp-a.

Papp-a and beta HCG are looked at in your screening test, along with your demographics such as age, smoking status and weight and the NT measurement. Low papp-a on its own is only a potential indicator of growth restriction and raised maternal blood pressure later in pregnancy, woman are usually started on aspirin and have growth scans but not offered an amniocentesis so their must have been more to the result in your first pregnancy🙂

So low Papp a is correlation not causation to potentially placental issues and FGR, low Papp a alone does not warrant induction. For the vast majority of women with low Papp a they have ‘normal’ birth weight babies. However, it’s typically advised to start 150mg of aspirin In the evening and then growth scans starting at 32 weeks (earlier if there are other factors).

Check out the saving babies pathway and ask if your hospital follows it. It talks about the guidelines for induction for a small baby. No mention that you should be induced for low Papp a alone. Xx

I recently had my combined results come back with a 1:23 risk of downs syndrome. The NHS now offer NIPT test for free and so I had this test done. After an agonizing wait my result came back today as low risk thankfully. My papp.a was super low 0.16 so I'm on aspirin until the end of pregnancy and extra growth scan from 28 weeks. Why not ask the midwife if you can go straight to NIPT test? (Not sure if you would still show your hormone levels to see if you have low papp.a this time though). Xx

Yes I’ll ask the consultant first , it was nothing on the scan that made me high risk - possibly age / weight that drove up the odds with the Papp-a. It was a few years ago so can’t remember the full details but they did tell me it was mainly due to the Papp-A.
@Mrsmujic I’m trying to avoid that again using wait it’s such an anxious time . Will explore the options on my first appointment.

OP the harmony test is a NIPT test. Can you just pass the fact that was all low risk on to your midwife? X

@SaraKitty do you have reason to believe it's a high risk pregnancy? I don't think they will offer an invasive test straight away before you have a screening test which shows a high chance? I know the wait is awful but percentages are on our side that it will all be okay in the end X

I have low Papp a and am on aspirin and have 3 growth scans booked in. My consultant (I was under anyway for thyroid) said the vast majority of people don’t have small or prem babies but they treat everyone the same just in case. No complaints from me, happy to have extra scans! No talk of induction or anything (I would refuse) but I don’t have a growth scan for another 4 weeks and I don’t see the consultant again till November so it could all change
My 12 week screening bloods were all Normal/low risk aside from Papp a

£300 is a good price for NIPT. I'm about to pay £400 for a private NIPT at 10 weeks (IONA test - results supposed to come back within 5 days, fingers crossed). I read that NHS NIPT won't be offered until/unless your results from the NHS scan and tests at 12 weeks come back as high (so could potentially be at 14 weeks or more gestation at NHS NIPT results - another month).

However I'm higher risk at age 40, so want it for reassurance asap (first/only baby after multiple IVF and I'd rather know sooner rather than later if I have to make a horrible decision). I think you can get the private NIPT and still have all the NHS scans/tests at 12 weeks - including the Papp- A? That's what I'm hoping to do.