Low PAPP-A in pregnancy
If you have received a letter from the Antenatal and Newborn Screening Team telling you that you have a low PAPP-A result, you may understandably have some questions about what this means for you and your baby.
The most important thing to know is that most women with low PAPP-A have a straightforward pregnancy and a healthy baby.
Having low PAPP-A does not mean that there is something wrong with your baby.
Your result gives us some additional information about your pregnancy and means that we would like to offer you some extra monitoring as your pregnancy progresses.
Your result at a glance
-Most women with low PAPP-A have a straightforward pregnancy and a healthy baby.
-We recommend low-dose aspirin to reduce the chance of some pregnancy complications associated with how the placenta develops and functions.
-We will offer you additional growth scans, usually starting at around 28 weeks.
-You don’t need to arrange these scans yourself. We know about your result and will arrange the appropriate follow-up.
– Continue with your usual antenatal care and your pregnancy as normal.
What is PAPP-A?
PAPP-A stands for Pregnancy Associated Plasma Protein-A.
It is a protein produced by the placenta and is one of the measurements taken from your blood as part of combined screening in early pregnancy.
Your blood test has shown that your PAPP-A level is lower than expected.
Low PAPP-A is not an illness and does not mean that there is something wrong with your baby.
What happens next?
Low-dose aspirin
At NNUH, we recommend 150 mg of aspirin each evening for women who meet our criteria for low-dose aspirin in pregnancy.
Low-dose aspirin can help reduce the chance of some complications associated with how the placenta develops and functions.
Please follow the instructions in the letter you have received about when to start and stop taking aspirin.
If you are allergic to aspirin, have previously been advised not to take aspirin, or have a medical condition or take medication that may make aspirin unsuitable for you, please speak to your midwife, GP or maternity team before taking it.
Please read our copy of the Low Dose Aspirin in Pregnancy Patient Information Leaflet.
Additional growth scans
We will offer you additional ultrasound scans later in pregnancy to check that your baby is growing as expected.
Your first additional growth scan will usually be at around 28 weeks of pregnancy.
At your scan, the sonographer will take measurements of your baby and assess their growth.
Further scans will be arranged according to the NNUH pathway and your individual circumstances.
You do not need to contact the screening team to arrange these scans. We know about your result and will arrange the appropriate follow-up for you. However, if you have not received a date for your 28 weeks scan by the time you are 22 weeks, please call 01603287949 so we can look into this for you.
What do I need to do now?
There are just a few things we would like you to do:
- Take your low-dose aspirin as recommended in your letter.
- Continue to attend your usual antenatal appointments.
- Attend the additional growth scans that we arrange for you.
- Continue to follow the usual advice for a healthy pregnancy.
Otherwise, continue with your pregnancy as normal.
Frequently asked questions
Q: Have I done anything to cause my low PAPP-A result?
A: No.
There is nothing you have done, or haven’t done, that has caused your PAPP-A level to be low.
It is not caused by your diet, exercise, work, stress or anything else you have done during your pregnancy.
Q: Is there anything I can do to increase my PAPP-A level?
A: No… and importantly, you don’t need to increase it.
PAPP-A is measured during early pregnancy because the level gives us useful information about your pregnancy at that particular time.
Once we have this information, we don’t need to try to change the PAPP-A number itself.
Think of PAPP-A as a marker that gives us some additional information, rather than something that needs to be treated or corrected.
There are no foods, supplements or lifestyle changes that have been shown to increase your PAPP-A level, and we don’t routinely repeat the PAPP-A blood test later in pregnancy.
Instead, we use the information it has given us to plan your care. Our focus is on supporting a healthy pregnancy by recommending low-dose aspirin and monitoring your baby’s growth.
Q: I smoke or am exposed to second-hand smoke. Does this affect my Low PAPP-A?
A: Smoking and exposure to second-hand smoke can increase the risk of reduced fetal growth, which is also a risk associated with Low PAPP-A. Reducing or stopping smoking, and avoiding exposure to second-hand smoke where possible, can help reduce this risk.
Speak to your midwife for support, or you can self-refer to smoking cessation support using the link below.
SmartStart – Smoke free maternity support in Norfolk and Waveney | Smokefree Norfolk
Q: How low is my PAPP-A result, and does a lower result mean there is a greater risk?
A: PAPP-A is reported as a MoM (Multiple of the Median), which compares your result with the expected level at the same stage of pregnancy.
Although very low levels can be associated with a greater chance of some pregnancy complications, your PAPP-A number cannot tell us what will happen in your individual pregnancy.
Most women with low PAPP-A have a straightforward pregnancy and a healthy baby.
This is why we focus on how your pregnancy progresses rather than the PAPP-A number alone.
Q: Does low PAPP-A mean there is a problem with my placenta?
A: Not necessarily.
PAPP-A is produced by the placenta, but a low result does not mean that your placenta isn’t working properly now.
Low PAPP-A is associated with an increased chance of the placenta not working as effectively later in pregnancy.
This is why we recommend low-dose aspirin and offer additional scans to monitor your baby’s growth.
Q: Does low PAPP-A mean my baby has a chromosome condition?
A: No. Low PAPP-A on its own does not mean that your baby has a chromosome condition.
PAPP-A is one of the measurements already used to calculate your combined screening result for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome.
You will have received your individual combined screening result separately.
If your combined screening result required any further discussion or testing, the screening team would contact you.
Q: Does this change the combined screening result I have already received?
A: No.
Your PAPP-A measurement has already been included in the calculation of your combined screening result.
Your low PAPP-A result is now being used separately to help us plan your ongoing pregnancy care.
It does not change the combined screening result you have already received.
Q: Why do I need aspirin if most pregnancies with low PAPP-A are normal?
A: Most women with low PAPP-A will have a straightforward pregnancy.
However, low PAPP-A is associated with an increased chance of some complications related to how the placenta develops and functions.
Low-dose aspirin can reduce the chance of some placental-related pregnancy complications, which is why we recommend it as a preventative treatment.
Q: Is low-dose aspirin safe for my baby?
A: Low-dose aspirin is commonly recommended during pregnancy for women who have an increased chance of developing certain pregnancy complications.
Please take 150 mg in the evening as advised in your letter and follow the instructions about when to start and stop taking it.
Q: What if I don’t want to take aspirin?
A: It is your choice whether to take aspirin.
If you have concerns about taking it, please discuss these with your midwife or doctor. They can explain why it has been recommended, discuss the benefits and answer your questions so that you can make an informed decision.
If you are allergic to aspirin or have previously been advised not to take it, please speak to your maternity team before starting it.
Q: Why isn’t my first additional growth scan until around 28 weeks?
A: We understand that waiting for your first additional scan can feel worrying.
The purpose of these scans is to monitor your baby’s growth later in pregnancy, when ultrasound measurements can help us identify babies who may not be growing as expected.
Having low PAPP-A does not mean that we expect there to be a problem before this time.
Please continue to attend your usual antenatal appointments in the meantime.
Q: Will I have more scans after my 28-week scan?
A: You will have further growth scans following your first additional scan. These will be every 4 weeks until your baby is born.
Q: What happens if my baby measures small?
A: If a scan suggests that your baby may be smaller than expected, we may offer additional scans or monitoring and, if appropriate, arrange for you to see an obstetric or specialist team.
This does not necessarily mean that something is wrong with your baby.
It means that we would like to monitor your baby more closely and make an individual plan for the remainder of your pregnancy.
Q: Do I need consultant-led care?
A: Not necessarily.
Having low PAPP-A does not automatically mean that you will need consultant-led care throughout your pregnancy.
Your care will depend on your individual circumstances and how your pregnancy progresses.
If you and your baby remain well, much of your care may continue with your midwifery team alongside the additional monitoring we have arranged.
If a concern develops that would benefit from obstetric review, your maternity team will discuss this with you and arrange the appropriate care.
Q: Will I need to be induced because I have low PAPP-A?
A: Not necessarily.
Having low PAPP-A does not automatically mean that you will need to have your labour induced.
Recommendations about when to have your baby will be based on your individual pregnancy, including your baby’s growth and wellbeing, your health and whether any other concerns develop.
If we recommend giving birth at a particular time, your maternity team will discuss the reasons and your options with you.
Q: Can I still have a vaginal birth?
A: Yes. Having low PAPP-A does not automatically mean that you will need a caesarean birth.
Your options for birth will depend on how your pregnancy progresses and your individual circumstances.
Your maternity team will discuss your birth choices with you during pregnancy.
Q: Can I still give birth on the Midwifery Led Birthing Unit (MLBU)?
A: Having low PAPP-A does not automatically determine where you will give birth.
Your options for place of birth will be discussed with you later in pregnancy, taking into account your individual circumstances, your baby’s growth and whether any other factors have developed.
If you are hoping to give birth on the MLBU, please discuss this with your midwife.
Q: Can I still have a home birth?
A: Having low PAPP-A does not automatically mean that you cannot consider a home birth.
Your maternity team will look at your pregnancy as a whole, including how you are, how your baby is growing and whether there are any other factors to consider.
If you are interested in having your baby at home, please discuss this with your community midwife so that your individual circumstances and choices can be discussed with you.
Q: Do I need to do anything differently during my pregnancy?
A: For most women, no major changes to everyday life are needed because of a low PAPP-A result.
Take your low-dose aspirin as recommended, continue to attend your usual antenatal appointments and attend the additional growth scans we arrange for you.
Otherwise, continue to follow the usual advice for a healthy pregnancy.
Q: Are there any symptoms I should look out for?
A: Low PAPP-A itself does not cause symptoms.
You should follow the usual advice given during pregnancy about when to contact maternity services.
As your pregnancy progresses, this includes contacting maternity services if you are concerned about your baby’s movements or if you experience symptoms that you have been advised require assessment.
You do not need to monitor yourself for symptoms specifically because you have low PAPP-A.
If you are ever concerned about yourself or your baby, please contact maternity services using your usual contact numbers.
Q: I’ve read worrying information about low PAPP-A online. Should I be concerned?
A: It is understandable to look online for more information after receiving an unexpected result.
You may find information about complications that can be associated with low PAPP-A. However, online information may focus on possible complications without explaining that most women with low PAPP-A will have a straightforward pregnancy and a healthy baby.
Every pregnancy is different, and comparing your PAPP-A number or pregnancy with somebody else’s cannot predict what will happen in your pregnancy.
We recommend using information from trusted sources such as NNUH and the NHS.
If you still have questions after reading this information and watching our video, please contact your maternity team.
Q: Will having low PAPP-A in this pregnancy mean I will have it in future pregnancies?
A: No, not necessarily.
PAPP-A is measured separately in each pregnancy.
Having a low PAPP-A result in this pregnancy does not mean that you will have low PAPP-A in a future pregnancy.
If you choose combined screening in a future pregnancy, your PAPP-A level will be measured again.
Low PAPP-A can occur again, but most women who have low PAPP-A in one pregnancy will not have a low result in their next pregnancy.
Your maternity team will also take into account what happened during this pregnancy when planning your care in any future pregnancy.
Q: Who should I contact If I have a question specifically about my low PAPP-A or screening result?
A: Please watch the video and read the frequently asked questions above first, as these answer many of the questions we are commonly asked.
If you still have a question about your screening result, please contact:
NNUH Antenatal and Newborn Screening Team
Telephone: 01603 287949
Opening hours: Monday-Friday 8.30-4.30
You do not need to contact us to confirm that we have received your result or to arrange your additional growth scans. We have your result and will arrange the appropriate follow-up.
I have a question about my routine pregnancy care.
Please contact your community midwife using your usual contact details.
I am concerned about myself or my baby.
Please use the usual NNUH maternity contact route you have been given for pregnancy concerns.
Do not wait for a response from the screening team if you require maternity assessment.
Further information
- Low Dose Aspirin in Pregnancy – Information about the use of low-dose aspirin during pregnancy, including why it may be recommended and how to take it safely.
- Information for Women with a Low PAPP-A Result – Trust information explaining what a low PAPP-A result means and what additional monitoring or care may be offered during pregnancy.
- Pregnancy – Best Start in Life – NHS – NHS information and guidance covering pregnancy, including antenatal care, health and wellbeing, and preparing for birth.
- Pregnancy – NHS – The NHS Pregnancy website gives advice on pregnancy, health, antenatal care, labour and birth.