Anyone else had low PAPP-A result?

[alittleteapot]

I had 12 week scan today and nuchal fold was good (1.4) hCG was normal, baby looked fine, but my PAPP-A was low and they've calculated my risk for downs as 1 in 86 based on this. Busy googling away while deciding what to do next if anything. Would love to hear if anyone else had this and if there are any other explanations for this low result?

TIA

Yes I had exactly the same thing at my 12 week scan, and we were given a high-ish risk for Trisomy 13 based on my low PAPP-A result. (Like you, nuchal measurement was fine.) We decided to have a CVS, which showed that the baby was chromosomally normal. So I guess the initial decision you have to make is whether you want further invasive testing.

As I'm sure you've discovered from googling, assuming your baby is chromosomally normal, the low PAPP-A may indicate a later problem with growth (which would mean you might have to deliver early), or may give you a slightly higher risk of developing pre-eclampsia, or going into labour prematurely. Everyone has been quite keen to reassure me though that although my risk of these things is increased, it is still quite likely that none of them will happen. It may just be 'one of those things'.

My 20 week scan looked fine, but I will have to have another scan at 28-30 weeks to check how the baby's growing.

Hope this is of some use. Were you told how low your PAPP-A is?

Thanks joanneg20 that's really good to hear. My PAPP-A was 1.457 IU/I equivalent to 0.319 MoM.

What I'm struggling with at the moment is the miscarriage rate for CVS at my hospital is 1 in 50 which is higher than the risk of my baby having a problem. That seems a bit perverse. So if I do have CVS I want to track down someone who has a better hit rate than that.

How low was your PAPP-A?

Mine was 0.299, so a bit lower than yours. The CVS thing is a very personal decision, I just felt I 'had to know'. It also partly depends on what you would decide to do if you had a CVS and did receive bad news. i.e. if you would continue with the pregnancy regardless, then it's probably better not to take the risk at all. Another option I think (though I know less about this - I'm sure someone else will be along who knows more) is that you could wait until around 16 weeks and have an amnio, which I think has a lower rate of miscarriage than the CVS.

we've basically decided we want to try and have the integrated test done privately. that's where a further blood test is taken at 15-16 weeks and it's supposed to be much more accurate than the combined test alone. if we're still high risk we'll go for amnio which is lower risk than cvs of miscarriage. it means waiting but it's only three weeks and i just feel 1 in 50 chance of miscarrying is too high a price to pay for knowing.

Thanks for sharing your story it's good to hear - good luck with the rest of your pregnancy.

Thanks LeninGrad and good luck with the rest of your pg. Just arranged for integrated test and hope I get a similar result to you. God pregnancy is a minefield!

Hi everyone... My story is very similar. My 12 week nuchal was fine, but my HCG was a little high and my PAPP-A was very low.. 0.21. With my age, my risk for DS went down from 1:250 to 1:35. We decided to go for an amnio at 17 weeks. The baby is just fine and I am now 23 weeks. My 20 week scan put the baby a little big for his age, but he looks great! When we went to see the genetics counsellor before the amnio, she told me that PAPP-A is related to placental function. Because mine was low, I would need to do a growth scan between 32-36 weeks to make sure baby is growing. My OB will also keep closer watch on his growth throughout the pg. She also told me that some women just metabolize the protein quicker, and that I may not have any issues whatsoever. (this is baby #4 and I have never delivered early).

To all you ladies going through this right now... I know its scary, but try to think positively. The amnio was painless and the chances of m/c are really low. I have never had CVS, so I can't speak of them. Just make sure the doc performing the procedure has a good many of them under his belt.

Good luck to everyone, and hope you have wonderful pregnancies and healthy babies!

Thank you for your timely message babyblue3. i've just had my first moment of feeling really tearful and down. the age factor is huge. i'm 38 which puts my base at high risk anyway, but i've read the age is the most unreliable marker at only 32%.

Good luck with the rest of your pregnancy and thanks again for taking hte time to share your story.

Teapot - I will be 37 this year, so I know how it feels. If I had been 25 with the same score, it would not have even registered outside the norm. I won't tell you not to cry... because I spent many hours crying, even after the genetics counsellor told me that women with my scores usually turn up with healthy babies. Our children are so vulnerable, and mums are so protective. Throw in pg hormones and its a recipe for endless tears! I think the waiting is the worst. It took nearly a week from the time of the dreaded call with my results, til I got my amnio done. And as I mentioned, the amnio was more scary than painful. it was over in 5 minutes and I spent the rest of the day in bed (more out of paranoia than necessity) with minimal cramping/discomfort. Please... feel free to ask me anything. I had excellent support from the lovely ladies on MN where I post regularly. I would love to return the favour. All the best xx

Anyone know where i can find a table or some kind of guide on what PAPP-A scores fit where in terms of percentiles and causes for concern?

(Ok so I'm becoming a train spotter about this now, but I can't help it!)

I am not sure you will be able to find one. From the sounds of what my genetics counsellor told me... they feed all your scores (from nuchal and from all your bloodwork, plus your age) into a computer, and it spits out your odds. I think it would be too complex to make into a simple chart.

I am 29 & had a low papp-a reading at 12 wks (0.6 iu/i). My hcg level was not good either (I think they said too high) of 64.0 iu/i.... all of which is not good for my age apparently & leaves me with a 1 in 50 risk...
Nuchal fold was 1.82 & CR length was good also. And no other problems...

I have decided to do the amnio at week 16...and am fretting...this is my first pregnancy. No idea what all these numbers mean...still yet to see my obstetrician...

Does anyone know of a similar story with a positive ending...?

Hello becf, well since I got my low papp-a result I have scoured the internet and yes there are lots of positive stories. But no guarantees, of course.

For what it's worth, after my 1 in 86 result with the combined test (which sounds like it's the same as what you had) I went to the Fetal Medicine Centre in Harley Street where they can scan for more markers on the baby (nasal bone, heart valve, vessel in stomach) which is the most detailed screening you can have at 12 weeks. Based on this, combined with bloods and my age, they recalculated my risk and to my complete astonishment it was now 1 in 1619. It was £150 for the scan and that goes into their charitable research foundation so imo money well spent.

I was already feeling uncomfortable with the risk factor of invasive tests so this reassurance was great to have, though inevitably once someone's raised the worry flag it's hard to say goodbye to it.

I don't know where you live, and obviously don't know what your results would be, but it might be worth having this done so you have a clearer picture of the situation before deciding on the amnio.

Good luck.

Here's the link for the Fetal Medicine Centre:

www.fetalmedicine.com/

Thanks for your message (little teapot). Friends & relatives keep telling me of people who had similar (bad) blood results @ the 12 week mark & went on to have healthy bubs...so I am staying as positive as I can.
I am in Australia (Brisbane)..I take it you are London based.
I've booked the amnio...you're right, unfortunately once someone puts that doubt into your head it's hard to relax
My scan had all the right physical aspects present (nasal bone / thin nuchal etc)...so hopefully she / he is ok. I was 1 in 50 though...so quite bad odds compared to most my age.
Good luck with your pregnancy

Hello everyone

I just thought I would post my experience on this forum as I have found everyone?s posts useful and reassuring in relation to my own experience.

I am 29 years old and having my first baby. I had a nuchal scan and blood tests done at 11 weeks. The NT was 1.9 (within range) however my bloods came back with low Papp-A and raised hCGD levels. I was given a 1 in 50 risk of having a child with downs syndrome. My risk factor in relation to my age alone should have been 1 in 1,000.

My blood results were:-

AFP 4.6 U/mL
hCGD 51.6 U/L MoM 1.17
PAPP-A 535.0 mU/L MoM 0.33

I was offered further diagnostic testing and decided to have an amnio done at 17 weeks. Although I did have to wait a while, I opted for an amnio because I felt that the risk of miscarriage was relatively lower (0.5-1%) than having the CVS (1-2%) at my hospital. The actual procedure was not painful. The needle felt like a blood test needle. I felt tender afterwards but felt fine the next day. I was advised to rest for the next two days. I was told the results would take up to 3 days to come back. However, I phoned up the next day on the off chance to see if the results had come through and they had. I was told that it appears that there are no chromosomal abnormalities i.e. negative for Trisomy 21, 18 and 13. I was so relieved. It has been a very stressful experience but try not to worry. The consultant, midwife and my husband kept telling me that there was a 98% chance that the baby did not have DS but I just kept thinking about the 2% chance. I know it?s hard but try to keep positive.

I hope this helps people who are going through this.

Good luck!

Hello ladies!
Can someone help me with this?
I am confused with my NT results from my 12 weeks scan. I was 40.5 at the time and came back low risk 1-1666 fro DS and 1-2419 for Tri 13/18

However my bloods are confusing me
Papp-a was 0.42 MoM
HCG was 0.55 MoM

Both of these are very low and should increase my risk right???

I did have a NT measurement of 1.5
and nasal bone present but I can;t imagine this would take me from 1-90 to 1-1666

I nervous that the test was done properly.

Thanks!
MC

mellocello, raised risk of Downs Syndrome (not sure about other chromosomal abnormalities) is associated with low PAPP-A and high bHcG, so the fact that both of yours are low may explain why you don't have a raised risk. I'm not an expert though, just been through this a bit myself (I was give a 1 in 19 risk with low PAPP-A and high bHCG).

Thanks ladies!

I am wondering if I should go for an amnio anyway...for some reason this is really worrying me.
I did have placenta previa up until 20 weeks but it resolved itself.
Does anyone else know if this can contribute?
Also so far my growth has been on track but perhaps if will be a problem it will be later on in the pregnancy?
Ugh...I wish I could stop worrying!

xMC

I'm guessing (and this is just a guess) that as spaceal says, you don't have the high bHCG. Which should in theory mean you have a bigger risk of one of the other trisomies (can't remember which) which has both of those numbers low. However, neither of them are super low, so presumably not low enough to put you into a risk zone, especially combined with a good NT.

That's my interpretation anyway!!

PS - the low PAPP-A thing only becomes a potential problem for growth at post 28-30 weeks. And it's really low PAPP-A, below 0.3 to 0.4 that they are concerned with. So you're just above borderline!

My PAPP-A was 0.2 (and then 0.29 5 days later). I actually spoke to Prof. Nicholaides himself (one of the people who came up with the cursed integrated NT screen!) a few weeks ago when I went in for a detailed scan and he said that with my levels, only 5% of babies would have a growth pattern below normal. Having said that, one of my friends was 0.23 last year and did have IUGR but she was just very unlucky by the sounds of things.

Thanks Sparklies for the info. I didn't realise that papp-a could fluctuate. I have got another scan in a few weeks and see where things are at re growth placenta etc.

My pregnancy is IVF so it is easy to get in the habit of worrying about details right from the beginning! They throw levels and stats at you right from the word go....

Anyway, I appreciate your response!

xMC