Low PAPP-A. Any advice?

[StrawberryHalo]

I had my 12 week scan last Friday where everything looked okay - baby was very active and wriggly which was reassuring to see. However, I had my blood results back earlier this week where it was found that I have a low value of PAPP-A at 0.36 MoM.

My HGC and NT levels were both in the normal range, and I am at low risk for Down’s, Edward’s, and Patau’s.

I am really worried about the low PAPP-A and potential complications/risks associated. The midwife I spoke to on the phone was lovely and said this is relatively common, not a cause for concern and that they just want to monitor me and the baby more closely but I can’t help but feel really anxious about this. I had a miscarriage last year so I am naturally really high alert.

Does anyone here have any experience of low PAPP-A and outcomes? Thank you.

I had a low PAPP-A score with DD1 which meant I was offered extra scans to monitor growth. I was equally anxious (we had been through IVF to get there) and then at the first extra scan the doctor said it wasn’t anything to worry about and inferred I needn’t have been referred!

Everything was fine and I learnt to take the positive of extra scans meant more opportunities to see my baby on screen. DD1 is now 13.

Good luck and try not to worry. The overwhelming odds are that everything is completely fine.

congratulations on your pregnancy!

I had low PAPP - A my last pregnancy, baby number 3. I was also low risk for Down syndrome etc. I was also really worried about this. I had extra growth scans at 30 and 36 weeks. Baby was born via planned C-section at 39+4 weighing 8lb exactly. She is a very healthy nearly 4 month old. I had never heard of it before but by the sounds of it it’s pretty common and often not a cause for concern x

0.36 is really not that low - you're only just under the 0.41 threshold for "low". I had a level of 0.17 in a pregnancy once!

The majority of pregnancies won't have any issues with it. About 1 in 10 IIRC will have some kind of growth restriction right at the end of pregnancy but they will give you growth scans if they think your level is low enough to be a risk, so they will spot a problem if there is one.

This was a while ago for me so do Google yourself and check that 1 in 10 stat. There is tonnes of info about low papp-A so it's really easy to find out everything you need to know.

Also had low Papp-A but we weren't told until the 20 week scan and it was dropped into conversation like we knew. Which meant I completely panicked! All was fine. It just means you get more monitoring, I had weekly consultant appointments and scans every two weeks I think and you may end up under a consultant rather than midwife. I got induced at almost 38 weeks as she had stopped growing and she was born at 38 weeks 5lbs 10. She quickly caught up once out and you'd never know she was born that light as she's now quite tall for her age. Its very easy to spiral and panic as I've been there but it will be OK.

Thank you for your reply.

I am so glad that everything was okay with your DD! I am grateful this means I will get more opportunities to see baby as I am very anxious each week due to not really having symptoms nor showing yet so any chance I can get to see that they are okay will be reassuring!

This is wonderful! So pleased that everything went smoothly for you and your little one. Thank you for sharing.

I also hadn’t heard of this before but I was told it’s relatively common by the midwife! X

Oh wow! How did everything go in your pregnancy where your level was 0.17?

I have also read the 1 in 10 statistic when looking at online forums but I will probably do some further research into it for my own peace of mind (or insanity!) thank you for replying x

Oh my goodness that must have been so terrifying for you! Did your bloods from week 12 not show anything or had they just not communicated it to you? I’m really glad all was okay for you and your little one though.

I can’t help but worry myself although I am reassured by the fact that I will get extra monitoring and more opportunities to see baby x

Hello! I had low PAPP-A with my second pregnancy. I think it was spotted around 14 weeks and I was immediately advised to take a daily low dose aspirin (I think 75-100mg per day). I took it for the remainder of my pregnancy. I had extra growth scans from around 28 weeks and my baby’s growth rate did decline in the third trimester and my baby had FGR. The growth trajectory went from the 50th percentile to dropping off the chart in 6 or so weeks. I was induced at 36 weeks and had a 4 pound 10 oz baby - aside from a little jaundice he was happy and healthy! There was also no need for NICU, which I think they had been preparing for. I believe low PAPP-A is linked to FGR because FGR is the first sign of some form of placental insufficiency. After the birth, the midwife checked my placenta and said it looked healthy but was small. I believe the aspirin is taken to help the blood flow around the placenta so that it can essentially perform better.

I’m pregnant again and this time I’ve taken low dose aspirin since the moment I found out. I’ve been advised to take it until 36 weeks (they prefer you to stop in the run up to the birth because of risk of increased blood loss). I’m 32 weeks now and so far growth is looking good 🤞🏻 Baby is around the 27th percentile and that’s been fairly consistent (I think they are most interested in the growth trend rather than the actual percentile). My doctor this time said the aspirin is most crucial in the early stages of pregnancy (ie. The first 16 weeks) and doesn’t do so much later on, so better to take early.

Overall, I’d say don’t panic about the low PAPP-A, it’s quite common. It’s a useful heads up. You’ll be put on a specialist pathway where the hospital will simply monitor growth more closely so they can keep an eye on things. I’d ask about aspirin and whether they think it’ll be helpful at this stage. I’d also consider taking it earlier on in future pregnancies (although again aspirin isn’t right for everyone so double check!).

Sorry I probably could have said all this in two lines 😂 I hope it helps 😊

Please don’t apologise! Thank you for taking the time to share your story and explain all of this. I’m glad your little boy was okay and that your current pregnancy is progressing well.

I haven’t heard that aspirin doesn’t have much of an impact later on in pregnancy so that’s really useful to know! I have been taking 150mg daily since I found out on Wednesday as advised by the team who gave me my results. I’m sure two days is not enough time to have made an impact but I hope that’s not too late to have started and that doing so will help with improving blood flow to the placenta.

I think another reason I am worrying is because there isn’t really anything I can do now! I sort of just have to wait until the growth scans at 20/22 weeks to see what’s happening in there and I struggle with that. I have a reassurance scan booked for next week just to ease my own anxieties but I am grateful that I will be put on this specialist pathway with extra surveillance to make sure baby is okay.

I will definitely consider taking it for any future pregnancies! Is it safe to do so even if you haven’t been advised to by a professional? X

I also had low papp-a in my first pregnancy, not extremely low, it was very similar to yours. My midwife was very reassuring so I wasn't too worried, and I enjoyed the reassurance of having extra growth scans and more chances to see the baby. Far from being small my son actually ended up rather chunky! So it's great to have the extra monitoring just in case but usually everything will be fine.

On my second pregnancy now and my papp-a levels are within the normal range this time.

Thank you for your reply! I’m so pleased to hear that your son was okay, that’s really reassuring. Was he born at term or early, if you don’t mind my asking?

It’s interesting that you didn’t have the low PAPP-A with your current pregnancy (huge congratulations to you by the way!) but I do believe I read that it is on an individual basis so even though someone may have it one pregnancy, they may not for another!

Did you do anything different with your second pregnancy such as take aspirin earlier on? X

Hi OP, congratulations on your pregnancy! Whilst it may seem alarming, it’s just a risk and doesn’t mean anything will be affected but you should be offered additional growth scans and told to take a daily dose of aspirin until 36 weeks (I think). I had a low Papp-A of 0.14 and also a 1/13 chance of Down syndrome so I do know the worry. I also had placenta previa, which I found out at the 20 week scan which brought a whole host of additional worries and my waters ended up breaking naturally at 34 weeks and my baby was born via c-section at 35 weeks after a large bleed. As scary as the pregnancy was, my dd was born healthy and I have a very lovely 2yr old. Don’t be afraid to ask lots of questions and be seen if you’re ever worried. Low Papp-A is very common and I’m sure your pregnant will be absolutely fine. Best of luck

Thank you so much for replying and sharing your story! I have been offered a uterine artery Doppler scan at 22 weeks as well as additional scans at 32, 36, and 39 weeks although I feel like that’s a big gap between 22 and 32 with no scans! I have also been advised to take 150mg aspirin daily which I have been doing since I found out on Wednesday.

Did you have to have extra scans due to placenta previa? I can only imagine how worrying that must have been for you, but I’m so glad your little girl arrived safely and is doing well. 💕

I’ve been advised to continue taking aspirin in this pregnancy until 36 weeks… so it definitely must do something! I think maybe what the consultant meant was that it can be most effective in the first trimester when the placenta is forming and attaching? But, of course, it must still offer some benefits later regarding improved blood flow etc. Sorry if I caused any confusion… I live abroad so sometimes complex messages are delivered slightly clumsily due to translation! Great that you are already taking aspirin. I had heard that the advised dosage had been increased to 150mg so that all sounds encouraging. I think it will be effective immediately in improving blood flow in the region so I’d take comfort in knowing that you’re doing something useful.

You’re right that there’s not a lot else you can do beyond that - one of the most challenging parts of conception and pregnancy is surrendering our ability to control the process! But trust your body and the other posters here that it’ll do what it needs to do.

I went a bit rogue taking the aspirin so early this time around, but I did extensive research and felt instinctively it was the right thing for me. I actually had another child before my previous pregnancy and that baby was also small for their gestational age and had a few growth wobbles (although less concerning than second time around). So it just seems that’s a bit of a pregnancy complication I have, so I wanted to try and empower myself and pre-empt it by taking the aspirin early this time! I think you would need to get advice from a professional if you go for another baby in the future, because for certain groups aspirin is not advised etc. It’s essentially all a balance involving weighing up pros and cons!

Please don’t apologise! Thank you for clarifying. I suppose it makes sense that aspirin would have the most benefits the earlier you take it but it must still have an impact if it’s being prescribed until 36 weeks! Whereabouts do you live? 😊 I would guess France from your username!

You are absolutely right! I struggle with things beyond my control at the best of times, and trusting in my body especially since having a miscarriage but all my scans so far have been positive. I have another reassurance scan booked for next week just to help alleviate my anxieties and see that baby is doing well.

Did you also have low PAPP-A in your previous pregnancy if you don’t mind my asking? I hope that your little one is doing well now. The midwife I spoke to on the phone after I got my results asked in the conversation if I am small which made it seem like there are other factors at play which could contribute to a smaller baby but maybe it’s not that black and white. I am 4’11 as a matter of fact and my partner isn’t that tall. I can’t say I was ever expecting a huge baby but I was still taken aback when I got my results!

It’s brilliant that you listened to your body and advocated for yourself by taking the aspirin early this time around!

It is a long time without scans, especially when your anxious but in between the scans you’ll also have midwife appointments where they’ll measure your bump etc and any queries then they’ll refer you for a growth scan immediately. I had my first child abroad and it was standard practice to scan women every few weeks, it gave a lot more piece of mind!

I did have frequent scans with the previa but only because they were queuing whether it was also acreta (it wasn’t). I also had weekly Doppler scans to monitor babies heartbeat, which gave lots of reassurance too.

it’s great you’re already taking aspirin, that’s the main thing that can help low Papp-A and I seem to remember being told it’s more of an issue later on in pregnancy which is prob why they do more scans then and fewer before.

Yes that’s true! I haven’t had my first community midwife appointment yet so I keep forgetting that, I think it will be around 16 weeks so hopefully that will also provide some reassurance.

Scans every few weeks must have really helped! I just don’t think the NHS would ever have the capacity to offer that as standard unfortunately. I was a bit worried that I won’t be scanned again until 20 weeks in light of these results but as you say, I think this is because potential placenta issues rear their head further into the pregnancy.

Thank you for your kindness and support. 🩷

I had low Papp-A with my 1st pregnancy and I took aspirin and had extra scans. He was all fine and born 1 day before his due date. I've just had my 2nd and because of her position, I couldn't get the screening for low Papp-A, so they just treated it as though I did have it, and again took aspirin and had extra scans. I remember being really worried, but both of them were fine :)

I also had low Papp A with my second and he was born two days early at exactly eight pounds and is now two and absolutely perfect. I took the aspirin throughout but I also read a study which I think was done at a hospital in Liverpool which said cods liver oil was a better alternative to aspirin so after checking with my midwife I took it alongside the aspirin so might be worth looking up the study and asking your midwife

I had low PAPP-A with DS1 and was advised to take low-dose aspirin. All of the growth scans were fine and he was born above average in weight and size. He’s now in the 91st percentile! Please don’t worry, it is relatively common. And congratulations!

Thank you for replying and for sharing your story! I’m so glad to hear all was well with both your little ones. 💕

Did the blood test at 12 weeks not pick up on the PAPP-A levels with your daughter?

Thank you for replying! So glad to hear that all was okay with your little boy.

That is really interesting about the cod liver oil! I haven’t heard that but will definitely take a look into it. I wasn’t sure if it was allowed in pregnancy in general

Thank you so much! That is so reassuring to hear, I’m so glad all was well with your little one 🤗

Low papp-a with my second and he was actually my biggest baby at 9lb (well I’ve overdue with baby number 4 so maybe this one will beat the record).
Try not to panic xx