Low PAPP-A: did anyone go on to have problems?

[Moancup]

My blood tests have shown I have low PAPP-A. It’s 0.2 something so really is quite low. I’ve started on 150mg of aspirin at 14 weeks and my trust has already booked me an extra 28 week scan and I’ll also be scanned at 32 and 36 weeks.

Obviously it can be quite scary if you Google it, especially as one of the first results is a Tommy’s case study of a woman who went on to have a MMC at her 20 week scan. But it also seems like it’s a new and under researched area and lots of people have low PAPP-A without ever developing pre-eclampsia or or having growth problems.

My normal approach to risks in pregnancy is concluding that they’re massively overblown! Although obviously I’m taking the aspirin and accepting the extra scans. My practical fear is being chucked out of the midwife led unit or rushed for induction. I need to discuss my trust’s policy with the midwife, and I hope that by that point decisions are based on how the baby is actually doing at the scans.

I’m very interested in people’s experiences of whether it did end up being a complication?

Hi OP, I'm sorry you're going through this - it's a very worrying time. I'll share my experience to hopefully put your mind at ease a little.

Last year was my second pregnancy which was high risk due to low PAPPA and at the 12 week scan, a high risk of a DS diagnosis. We had a CVS performed on my placenta at 13 weeks and all results were clear. However because my PAPPA was so low (0.13 I believe) I too was put on aspirin which I continued throughout.

I had my standard 20 week scan, but it was much more thorough and done by the consultant. They agreed that my placenta wasn't functioning as it should be, which is one of the risks of low PAPPA. It meant DS wasnt getting the right bloody flow, and so high risk of low birthweight/preterm birth. We went on to have regular scans (every 2 weeks) from 28 weeks gestation. I also had routine blood tests and midwife appointments to check babies activity/heartrate.

After 9 months of worrying, watching every move, reading far to much on Google (it's a blessing and a curse!!) and terrifying myself. DS2 arrived at 41+2 and weighing 7lbs10oz!! For a baby that was predicted to be premature and low weight he sure did surprise us all! He's a cheeky 1 year old now who is into everything.

Please try not to worry and try to avoid Google, it really did scare me. Speak to your midwife, I had some lovely support groups around where I'm located which really helped. They also organised for me to visit the NICU so I could see what it was like, just incase DS did need the additional support. Ask all the questions you have at your appointments, I used to right a list of any that I'd thought of.

Good luck, and I wish you all the best for the rest of your pregnancy❤️

Sorry that you’re having a worrying time.

I also had low PAPP-A in my pregnancy as well as a two vessel cord. They advised there may be complications, baby might have to arrive early and have low birth weight due to less effective sharing of nutrients via the cord and placenta not working as well as it should. Started on aspirin after 12 week scans and was told we’d be having some additional scans through the pregnancy, as well as being consultant led, the midwife also suggested I might want to consider some additional private screening to give a clearer indication of any risk factors. We did Harmony screening which showed low indicators. After 20 week scan they were concerned the baby was small so ended up having bi-weekly growth/liquor scans. Then they thought I had gestational diabetes (I didn’t!). Then at 36 weeks they thought they should induce early as baby was “too big” and I may not be able to give birth naturally. I refused and asked to wait until my due date and if necessary, induce then.

Went into labour naturally on the morning of my due date and she was born weighing a perfectly healthy 7lb 7oz! Whilst I know all pregnancies are different, with mine I had so much anxiety and stress from all the appointments and tests - I wish I hadn’t known!!! Additional scans and time off work, baby too big/small etc. it was just a lot to deal with whilst being told to “keep calm” through pregnancy!

I hope everything goes ok for you x

Thank you. It’s all much more stressful than I thought it would be, but it does seem to work out fine for most people… writing down my questions is a good idea @grapevine45.

I had a similar level to you OP I had the extra scans which showed DD as very small, but the placenta was working fine.

I was very worried and towards the end was having scans every week. I had a bleed at just past 37 weeks so ended up having an induction then an ECS.

DD was 4lbs 12oz and at the bottom of all the growth charts. However at 4 months she was on yhe 25th centile for weight and is ahead of all her milestones. She is doing really well.

Good luck I'm sure it will all be fine x

Hi I had the exact same PAPP A level.
So baby began measuring fairly small in the last trimester. In my trust the policy is to induce at 38 weeks for low Papp A. This is because evidence shows that placenta functioning can decrease at the later stages with low Papp A.
So I always knew he would come early. I was also told I would not be allowed MLU birth due to these risks. Also on Asprin.

However at 35 weeks he’s growth had slowed down and the placenta wasn’t functioning well. Was induced at 36 weeks. He was a tiny 4 pound 11 and has since more than caught up.

Remember there is no guarantee that there will be complications. It just increases the risk. I would please take all the advise given. It sounds like your getting very good care and they are keeping a close eye on things. Hopefully it everything will be well.

Hello,

Sorry about this. I know it's such a worry as I've been through it. There's another thread here with some futher experiences www.mumsnet.com/Talk/pregnancy/4321892-Low-PAPP-A-Aspirin-in-pregnancy
I had a Papp A measurement of 0.38 at 12 weeks and I'm now 36.5 weeks, I'll copy my update from this week from there to here;

'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.'

x

I remember searching these same boards when this happened to me with my second pregnancy 😊
My PAPP-A was also around 0.2 and I opted for CVS and the Harmony test (offered via a trial at my Trust) which came back normal. Extra growth scans throughout - all normal.

DS was born 41+5 at 8lb 10oz and is now a strapping, energetic, fabulous 6-year-old. I was so scared at the start! Keeping everything crossed for you, too. Try not to worry too much.

I’m sorry for everyone who’s had stressful experiences with it. @JuneySunshine I think that is exactly my worry, that scans will suggest everything is fine but they still push for induction.

Hi OP, I work in an area of research related to PAPP-A and other placental hormones. I also have very low PAPP-A myself in this pregnancy: 0.15 MoM. Low PAPP-A is a risk factor but not a great predictor of any outcomes. The strongest link we have currently is between low PAPP-A and pre-eclampsia; around 20% of women with PAPP-A

@moancup Yep, as you can see from my post that's how I feel- that based on a one off reading at 12 weeks they've basically put a label on the pregnancy.

I've tried to be positive and think its nice to have the extra scans and attention, which to some extent it reassuring, but sometimes I feel they are looking for something wrong that isn't there.

Sounds like you'll be quite aware that when I said sweeps/ induction etc. that's advised not compulsory so I think I'm going to try and get all the information then push their timescales back if there's still no solid risks emerging. I'm a FTM to should be accounted for that baby might be a little later naturally anyway.

How do they find out about low papp-a? I'm not having the combined screening as I had the nipt. I'm 11 weeks

@Carebear99 It's from the blood test at 12 weeks which is part of the combined screening. The NIPT is a blood test as well isn't it so Papp A might also be included in that? Maybe worth mentioning to your midwife.

Hi , mine was 0.25 , it resulted in a higher risk NT , followed by harmony which was low risk . Went on to have a healthy baby with absolutely no pregnancy or health complications for either of us . X

Also I wasn’t given aspirin and I know a few friends who also had this low Papp-a reading who had no issues whatsoever. I had regular growth scans of course .

Update:

I had my 32 week growth scan yesterday and he has slipped right down. He was small but fine at 28 weeks but is now down on the 5th percentile. I’ve been referred to the consultant for another scan this week and to discuss options. The midwife did say they will likely advise getting him out anytime from now if his growth slips again though.

The cord and placenta look absolutely fine on scans and he’s super active, so it’s a bit hard to understand why he’s not growing properly or how life in SCBU could be better for him than my body!

I’d been worried about being pushed for induction at 38/39 weeks and now I’m crossing my fingers that I can even get to 35/36. It just seems far too early.

Thinking of you OP, please try not to worry, I'm now looking at my beautiful 9th centile 9 month old DD who was born on the 0.4th centile at 37+3. She is doing really well and meeting all her milestones.

Sometimes babies don't grow because there is a problem with the placenta, sometimes they are a small baby for other reasons. The first is a risk to the baby's life, the other means the baby is small. Mine came out at 4lb 11oz with very little fat and a lot of loose skin, she soon put weight on. Her dad is 5'7" and I'm 5' so she was never going to be a basketball player!

I read up on induction vs cesarean when it came to small babies and decided I wanted a cesarean. I was pushed for induction, there are good reasons why it's preferable, it can help their lungs a lot and cesarean before 38 weeks is not recommended, however they can give steroids to help. I was induced but my baby got into difficulty and I ended up with the cesarean anyway.

Weigh up the pros and cons, decide what you want and stick to it, it's your choice.

Good luck I'm sure it will all be fine.

Thank you @Magenta82

I think I need to draw up a list of questions for the consultant.

The midwife who had been doing the scans kept saying that I’m petite, but I’m 5’4 so not tall but not tiny, and DP is 5’11, so I fear it’s not just a genetically small baby.

Hi I am in my second pregnancy (36 weeks) and had low PAPP-a. I've been on Aspirin and had extra growth scans. Baby is on the 92nd percentile!

Sorry should have read the thread. I wish you all the best in the end of your pregnancy. Thinking of you x

I'm going through something very similar OP.

I was told low Papp A at combined screening (0.33), I was also 1/23 risk of downs from combined screening so I had NIPT (which came back low risk 1/10,000) and had a scan at the Fetal Medicine Unit with a consultant at 20 weeks to do a thorough check for abnormalities, baby looked absolutely fine so we didn't do an amnio and I happily forgot all about the Downs risk.

Due to low Papp A I've been on 75mg aspirin a day since and had extra growth scans booked in. 28 week scan was absolutely fine (baby was in 40th percentile) but had a scan at 32 weeks yesterday and she's plummeted down to <5th percentile. The sonographer started asking about the Downs test and whether I'd had an amnio which has terrified me that there's a problem that's been overlooked.

I went in for monitoring today and baby seems happy enough in there - heart beat, movements, etc all fine. I've got another FMU scan with the consultant on Thursday to check for any problems with her or the placenta. I'm so worried that something has developed.

I'll have extra scans and monitoring every week now and they've said the same to me that if the growth doesn't pick up I'll be induced early.

Trying to stay positive but I feel stuck in a weird limbo, firstly waiting to find out if she's physically OK and then just hoping she starts to grow.

Thinking of you and hope things go well with your consultant appointment.

Sorry to hear you’re going through this too @DCLon86 and with the added Downs uncertainty.

I completely relate to what you say about limbo. I want the consultant to tell me what the options are but realistically it’s still going to feel like limbo while they keep an eye on growth. It’s very weird to know there’s now an eight week window when I could have a baby.

I know, it's so weird! Feel so unprepared for her to come early and just so worried now😰

Low papp A is really common and generally although it carries risk it is well managed via taking aspirin, having dopplers (testing blood flow through placenta) and growth scans.
Rarely are there complications from Low papp A, googling it will always show you worst case scenario, so I would recommend speaking to your trusts Screening Midwife for any questions you have.

Hello, mine has ended up being a problem but this is rare from what I know. Baby fell from seventeenth centile to off the chart at twenty nine weeks. Now back up to third. The good thing is that if that happens they monitor you with tonnes of Dopplers and ctgs. I'm on my way to hospital now actually. It's scary but they are doing all they can and will do the same for you. My baby boy will have to be born between thirty four and thirty six weeks but I'm learning to be all right with that.

This is really rare though and I have autoimmune issues as well.

Sorry for posting before I saw your update. It looks like we're in similar situations.