Low PAPP-A During Pregnancy – Do You Need To Be Concerned?

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When my wife Kathy was pregnant with our second baby, her OBGYN detected that she had low PAPP-A levels. In this article, I will explain what PAPP-A is and why low levels often result in additional tests and monitoring.

None of that should freak you out! Scientific studies have yet to establish a clear connection between low PAPP-A and the increased risk of problems during pregnancy.

Pregnancy-Associated Plasma Protein-A (PAPP-A)

Early in the pregnancy we learned about a new blood test, called Harmony, that could more reliably detect trisomies 21 (Down syndrome), 18, and 13 starting at week ten. The test would also tell us our baby’s gender long before ultrasound-based gender determination takes place.

So we decided to do the test, and fortunately, it came back negative for all tested chromosomal abnormalities.

Of course, we also did the regular first-trimester blood screening that checks serum biochemical markers such as Pregnancy-Associated Plasma Protein-A (PAPP-A), human Chorionic Gonadotropin (hCG), Placental Growth Factor (PlGF) and Placental Protein 13 (PP13).

Low PAPP-A during pregnancy - what it means and do you need to be concerned?
Ultrasound of Lucas at week 12

Scientists and doctors measure PAPP-A as Multiples of Median (MOM), and earlier studies have suggested that levels =< 0.5 could lead to any of the following conditions:

  • Pre-eclampsia,
  • Small for gestational age (SGA) and
  • Preterm delivery

Kathy had PAPP-A levels of 0.5 MOM, but our doctor told us not to worry. She didn’t elaborate on what PAPP-A exactly was, what medical consequences low levels could have or what we could do if in fact there was an issue and we didn’t ask.

Frankly, we focused more on the fact that we’d be having a boy than on something, our doctor said, we shouldn’t be worried about.

But once the excitement had settled, both Kathy and I did some research, and we got concerned when we read about all the consequences low PAPP-A levels could have.

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We had just enough information to be worried but not sufficient information to understand the situation fully. But instead of wishing that we had never looked up PAPP-A, I was determined to learn enough to either put our minds at ease or at least come up with a strategy on what to do next.

The following day I spent a couple of hours researching the topic. Similar to my approach to healthy eating, I tried to steer clear of anything that smelled like an opinion and instead I looked for scientific studies on the subject.

Scientific Evidence

I found a couple of studies from the early 2000’s supporting the theory that low PAPP-A levels could lead to adverse pregnancy outcomes. Then I found a study that suggests that there is only limited clinical relevance between low PAPP-A and fβ-hCG levels and adverse pregnancy outcome.

Last but not least, I came across a meta-study (a study of existing studies with the goal of detecting a trend), from August of 2015 that states that there is no connection between low PAPP-A levels and an increased risk of pre-eclampsia, small for gestational age (SGA) and preterm delivery. The conclusion of the study is:

First-trimester screening analytes have low predictive accuracy for pre-eclampsia, small for gestational age and preterm delivery. However, the predicted value of first trimester analytes is not worse than that of the second-trimester markers.

It’s important to understand, however, that the study excluded patients with chromosome aberrations or fetal anomalies. In other words, low PAPP-A levels could still be an indication of chromosomal aberrations, unless otherwise ruled out.

Because of the Harmony test and nuchal translucency (NT) screenings we had done, we know that our baby boy doesn’t have any chromosome aberrations (with a 97% certainty) and hence the study’s conclusion would apply.

Low PAPP-A During Pregnancy

Despite the lack of evidence that low PAPP-A levels increase the risk of adverse pregnancy outcome, some pregnancies go differently than planned.

Low PAPP-A during pregnancy - what it means and do you need to be concerned?
Lucas at 11 months (corrected)

My wife delivered our baby boy prematurely at 30 weeks and six days. He spent 57 days in the NICU of Northside Hospital. He is healthy and has developed just like a full-term baby. After his delivery, a pathologist inspected my wife’s placenta to confirm if there was anything wrong with it.

Unfortunately, all tests were inconclusive, and we don’t know what caused Lucas’ premature delivery. PAPP-A was likely not the cause, but maybe an indication of another problem. I documented his incredible journey in my article Lucas – NICU to seven months (corrected).

Low PAPP-A – What You Can Do

While there is currently no drug or treatment for low PAPP-A, there is a lot you can do to increase your chances of delivery a healthy, full-term baby, including:

Relax and don’t stress

It might sound obvious, but stress has a negative impact on your and your baby’s health. So try to stay calm and do what you can to manage stress, including exercise, meditation, or yoga.

Eat Healthily

More than genetic predisposition, the food you eat directly impacts the expression of your genes and the risk of inflammation in your body.

The latter has been linked to all metabolic diseases we know, including those you are more likely to develop during pregnancy. If you are unsure where to start with improving your diet, check out my ultimate guide on healthy eating.

Get all your micronutrients

Your doctor has probably prescribed you a prenatal vitamin. Make sure you take it, but don’t forget that most of the vitamins and minerals your body needs should come from the food you eat.

Supplements, are the name implies, are just meant to supplement and otherwise healthy dietary lifestyle.

Also keep in mind that not all multivitamins are created equal. Most over the counter supplements contain synthetic versions of vitamins that your body can’t absorb as readily as their natural counterparts. I recommend sticking with a quality multivitamin*, such as the one your doctor prescribed.

Final Words

If you found this blog post looking for answers, I hope that I could provide some. Don’t despair and have trust in your doctors! Most importantly, keep your cool and don’t let the results of a test freak you out.

If your doctor diagnosed you with low PAPP-A levels, leave a comment and share your story with my readers!

174 thoughts on “Low PAPP-A During Pregnancy – Do You Need To Be Concerned?”

  1. I am 12-13 weeks pregnant with my second child and they diagnosed low level of PAPP-A 0.2. My doctor told I must give another test called NIPT that will will show more accurate chromosome analize of baby. I worry too much sometimes I just cant control my emotions I cry I am nervous I dont go out .I dont know how to overcome all this. Please if you passed through this share with me and help me to overcome this fear.

    Reply
  2. Well, this has made me feel a little more at ease after spending a full day worrying! I’m nearly 15 weeks pregnant and have been informed that I have a PAPP-A Level of 0.37 from my 12 week scan, and advised to take 75mg Asprin daily until the birth. I’m in London and have a great hospital down the road, they don’t seem to be too worried, even after expressing the high-risk factors associated with low PAPP-A Levels. I don’t know. I’d never heard of it before. It doesn’t seem to be too widely spoken about.
    They’ve booked me in for a growth scan at 31 weeks, but apart from that, I’m only booked in for my 20 week scan in a month. I guess my question is, do you think I should be requesting more monitoring throughout my pregnancy? Between 20 weeks and 31 weeks? Our last pregnancy ended in a miscarriage towards the end of the first trimester, but my biggest fear is losing a baby mid to late-term and the dreaded stillbirth. I’m just really scared about that. I can’t help but feel like it’s my fault somehow, that maybe my placenta isn’t working properly, how can my body not want to provide for my baby, you know? But I suppose there’s really no point in even venturing towards that thought process, our worst fears lie in anticipation. Anyway, I know this is late in the day, but can’t really find any other threads online that give me comfort!

    Reply
    • Hi Jem,
      I am currently 28 weeks pregnant with a low PAPP A of 0.25. I had a scan at 20 weeks baby was normal size. I have other scans at 28, 32 and 36 weeks.
      My OB doesn’t seem too concerned which is worrying a bit but there’s not much I can do.

      Reply
    • Hi Jem.
      I’m in the same situation. 17 weeks . Papp 0.37.
      How is everything going with you ?
      My midwife knows nothing about it . I’m seeing a doctor on friday .
      I’m ridiculous nervous.

      Reply
      • 0.02 Low Papp here. Test results came back positive for the quad screen which were not true. The baby doesn’t have any defects or abnormalities which the NT SCAN cleared up anyway but the quad screen was after the NT at 16 weeks. Totally freaked and asked for a level 2 scan and NADA. Doctor suggested we go to CHOP in Philly but we tried getting a second opinion with another MFM and he got all our records and said he doesn’t see a placenta issue and denied our transfer. Now I’m wondering if this person is simply relying on the low papp for the placenta issue and I’m trying to save a trip to PHILLY. Will definitely see what our ob sent this new MFM. We’re 17 weeks today and IVF. Idk if because were Ivf that it triggered low papp or not. I’m just confused at everything going on. Anyone have something similar and are IVF also?

        Reply
  3. I would also like to add my story:
    After having been disgnosed with a low Papp-A value I took the harmony test which only worked with the 4th blood sample as in the first 3 samples there was not enough fetal DNA. I had to take care a lot anyway as my first child was born at 32+2 without a reason being found such that I layed down for almost all my second pregnancy. Around week 25 I had one strong bleeding but nothing else except that the baby was rather small. Around week 32 I then noticed that I am loosing very small amounts of amniotic fuild and went to the hospital where I got lungs mature and at 33+1 when the lungs mature was not fully over my son was born with 1790g and 41cm. From the first little pinching in my belly to his birth it was 1 hour. He was generally fine BUT doctors told me that he had a cerebral haemorrhage grade 2 to 3 in the time of 7 days BEFORE birth. They did ultrasounds, blood tests and an MRT but could not find the cause. Such a bleeding is very rare and I could hardly find any information on it. Thus I would be happy if anyone who experienced the same could tell me. However this is only detected when an ultrasound of the head is done at the right time as after some weeks the blood is degraded and everything looks normal again. After all I am happy about how it went. He is now 4 months old with 60cm and 6400kg, which is incredible, and seems to be fine.
    Please do not get scared by a low Papp-A value as for most cases there are no complications. I am very thankfull to remember having had this value as it helps me so much to see the cause of everyhing by something I could not have influenced. There is nothing worse than brooding that I could have done anything to prevent his premature birth or cerebral haemorrhage.
    With my daughter I felt so unhappy for a long time as the preterm birth was rather unexpected (about 1h before birth I was still told that I am not in labour and everything is fine) and I could not understand why it happened. With my son I am so much in love and everyday I am so thankful that nothing worse happened to him. He could have been borne after the strong bleeding I had in week 25 or they could have taken him out of me if anyone would have noticed the bleeding in his brain during the pregnancy and if he had stayed longer in my belly maybe by using tocolytics an even stronger bleeding could have happened or he could have died, no one knows.
    Just for your information: my daugher was borne one week earlier but was in a better shape: 1850g instead of 1790g and 44cm instead of 41cm, needed less coffein for stabilizing the breathing and could go home after 18 days instead of 23 days but after 4 months my son was larger and heavier than her. My daughter, now 2.5 years old, is doing incredibly fine considering her skills and no one would ever think that she was born premature. The only thing was that she was constantly coughing from about age 1 to 2.

    Reply
  4. I am 13 weeks and 3 days i have a low Papp-a and i risk of downs of 1 in 65 i have just done the Harmony test – and honestly i am freaking out, i can not stop thinking and worrying. This is my first baby, and it is so new being pregent and scared. Staying calm is what i am going to be taking from this and trying my hardest not to let the dark thoughts in.
    i hope all goes well for me and that baby is all healthy and safe. i already love the baby so much

    Reply
    • How is your pregnancy going A.B.R if you don’t mind me asking?
      I’m currently 14 weeks and 2 days and have a low level of 0.25.
      Freaking out is an understatement.

      Reply
      • Hi Megan, so far ok- i had a meeting with a food nutrition and she advise me to change my multi vitamins to a USA manufactured one which had zinc included whilst the one in UK which all the midwives recommend do not have zinc and has has recommended for me to start a a meditation program. i am staying positive and strong. I had the harmony test results back showing 1 in 10,000 chance which is good and has help me and my hubby to relax more.

        keeping postive and strong- lets see how things go. i shall try and keep this post updated :)

        Reply
        • Hi A.B.R,
          How are you going with your pregnancy? Have you had your 20 week scan yet?
          I have just had my 20 week scan today, baby is normal, and measuring normal size.

          Reply
  5. Hi, I’ve only just been told at 26 weeks that I have low papp.a, it’s actually .49 so right on the cusp but oh my gosh I am so worried now, I am also worried that maybe there’s something else wrong with my baby and they just haven’t seen it yet. My obstetrician said not to worry and I’m having routine ultrasounds but I am worried :(

    Reply
  6. I’ve had an ectopic pregnancy (tube removed) and one miscarriage. Then I gave birth to a healthy girl in Aug. of 2017. My PAPP-A was 0.29 and I had a few extra scans. My Ob/gyn had told me from the get go that she wasn’t going to let me go past my due date (I was 36 yrs old at the time). I was induced (given the gel) at 39+3 but nothing happened. They monitored her for hours and weren’t happy with her accelerations/decelerations etc.. and saying she wasn’t “happy”. They didn’t want to put her under distress, so waited until about 10-12 hours later to give me oxytocin. That didn’t do anything for me either. They even tried to manually dilate my cervix with a balloon thing, but that wasn’t very successful. She was delivered via c-section and had great apgar scores. Her weight was 7lbs 6oz. They found the cord wrapped around her neck once and she was stuck in my pelvis. A few weeks before her birth though I had asked for a scan because I couldn’t feel her unless I really poked at her to force her to move. They said everything was fine but I know that couldn’t possibly have been the case. I will never really know if the low PAPP-A was a factor in anything. Now I’m 4 weeks pregnant (38 years old), and wondering if I’ll have a low-PAPP-A again. I pray everything will go well with this pregnancy.

    Reply
  7. Low paap-a with my now 5 year old. I was 0.15 mom. My doc was not too concerned and anyway since I had gestational diabetes I was being monitored more frequently. I freaked myself out reading everything on the net. I wanted a Vbac so tried everything to go into labor before the scheduled c section at 39 weeks but nothing worked. Kid born 7 pounds at 39 weeks no issues no nicu stay etc. I asked my doc if the placenta looked fine and she said she could not see any calcification.

    Reply
  8. This is my first baby and I’m 19 weeks, I was told I have Papp-a but I’ve not been told how low. But I’m making myself ill and upset over thinking about what could happen.

    Reply
  9. I am 13 weeks pregnant and have been diagnosed with low PAPP A which in 0.08. Also, have been asked to do the amnioscentesis for trisomy 13/18 and 21. I am taking aspirin 150 MG as asked by my Gyny. What are the chances of healthy pregnancy?

    Reply
  10. I promised to come and put my experience everywhere I read the ‘horror stories’ of the low PAPP-A after they left me devastated when we found out mine. 0.152MoM I still cant even tell you what it means but if it werent for my midwives putting me at ease and explaining how there are so many factors that need to be in the wrong place for something bad to actually happen I would have remained devastated.
    My baby boy was born only 10 days early at 7lbs 9oz at home and he was and still is perfect 6 months later. My pregnancy was amazing, his birth was amazing and only 6 hours (first baby).
    If you are looking for info on the ‘Low PAAP-A’, please do yourself a favor and stop reading anything bad about it. Dont do to yourself what we did. Whats meant to be will be.

    Reply
  11. I was just told that I need biweekly non stress tests for the low PAPP-A that I had in my first trimester. I just did 10 minutes of research and found multiple current studies linking low PAPP-A to pre-ecclampsia, low birth weight, and pre-term delivery (which it appears that your wife had).
    I have experience interpreting scientific literature as I am a physician myself (although not an ob). From what you’ve written it seems you do not.
    In one study I found the rate of maternal complications to be 13%. So most people will be just fine. However to say the connection between PAPP-A and adverse maternal/fetal outcomes has not been established is misleading to your readers.

    Reply
    • Hi “Reader,”

      Could you link those studies you mentioned please, so others, including me can verify your statement? I see two possibilities here. 1) New studies or, ideally, a new meta analysis was released since I published the article in 2015, or 2) you don’t understand the difference between correlation and causation. For example, did you know that people who own a TV have a higher risk of cardiovascular disease? That’s a correlation and it doesn’t make me hesitant owning a TV. Also, people who smoke have a higher risk of developing lung cancer. That’s a causation. See the difference?

      You might also want to read the comment from Jose A Lopez-Zeno, a prenatal specialist who also happened to be the doctor who took care of our preemie.

      Reply
  12. Hello!!

    My Papp A was low, I am sorry I can’t remember what level but definitely very low, I had extra scans and worried myself sick throughout my pregnancy. At 36 +4 I had my final growth scan and his abdominal circumference had dropped < 5% so I was booked in for a c section at 36+ 6. They thought he was going to be 5lb and he came out at 5lb 6. My placenta was tiny but otherwise everything was perfect. Just wanted to give reassurance that sometimes low papp A is not as scary as what you read on the web! Thinking of all the future parents who are worried x

    Reply
  13. My PAPP-A was low in the 12th week scan and I found this article during my research. I thought back then I wanted to update with my story when I was done.
    While my worries over chromosome abnormality was alleviated by a following negative NIPT test, I developed new concerns over growth issues, preterm labor and stillbirth. I read a bunch of related papers and sent them over to my OB. My OB agreed to add a growth scan at 32 weeks and assured me that preterm labor and stillbirth was rarely seen as linked to low PAPP-A clinically.
    Everything else had been smooth sailing throughout my pregnancy. I was problem free with blood sugar and blood pressure. Weight-gain had been on track as well. At week 32, my baby was estimated at the 33rd percentile in her growth scan, and later at week 36, she dropped to the 9th percentile and therefore was diagnosed with IUGR. Her waist circumference was measuring low – reassuringly, her head circumference was okay.
    I was then scheduled for induction at 39 weeks so that baby girl could grow outside uterus sooner. The induction went south and an emergency C-section was performed. It was and actually still is traumatizing for me to think of the birth experience. Baby was born at 6 lbs at the 9th percentile and she was jaundiced during our hospital stay. But she was otherwise healthy. She breastfed within the first hour like a champ and she never needed the light therapy for her jaundice.
    Yesterday she turned 4 months, weighed a good 16lbs and 8 ounces at the 90th percentile. She smiles and babbles all the time. She is the happiest baby I’ve seen. I hope my story helps.

    Reply
  14. I just found out I have Low PAPP-A. I’m 12 weeks 3 days. I’m super worried now! I’ve had a miscarriage already. I’m a worry wart and always have been.

    Reply
  15. I had a low PaPp A level at 0.39mom. my midwife didn’t mention anything about it, and by baby was a good size at our 12 weeks scan. In fact they changed by due date and it was now 3 days earlier.

    However at my 20 weeks scan we discovered that our baby had polycystic kidneys causing other complications and lack of amniotic fluid.

    This put my baby in the excluded part of the study of babies with chromosome aberrations or fetal anomalies.

    PaPp A is something I will definitely bring up with my midwife when I hopefully get pregnant again.

    Reply
  16. I was diagonsed with low PAPP value 3.9 @12 weeks test. I was suggested additional scans for close monitoring. But everything went well, I delivered a healthy baby @39 weeks. She is 5 weeks now and healthy.

    Reply
  17. This was an article that gave me hope and I want to give you a sense of hope back sharing the positive story. My PappA was low (0.24) @ 12 weeks. I’ve been sent a letter suggesting closer monitoring. As I’ve had 2 preeclampsia’s before (with normal PappAs) I was already a high risk. Problems started around week 20 when the scan revealed some abnormalities. My baby had multiple echocenic foci in heart and a large calcification on the liver. We were told to consider amnio. I refused and had Harmony test done instead which came back – perfect. From week 21 I was on a blood pressure control. My placenta had a nice blood flow but was showing signs of early maturing. I was also diagnosed with recurring cytomegalovirus adding more “fun” to the process. I was worried sick. I was diagnosed with preeclampsia @ 28 weeks and put on 3/7 monitoring and more drugs. Placenta was also getting more calcified increasing the risks. Baby growth – amazing. From week 30 I pretty much lived in the hospital with unstable BP and chest pains (no it wasn’t indigestion) I had to have daily ctg scans. Week 32 -I started having contractions – we’ve managed to stop the labour (with more drugs). Week 35 the show had to go on as my preeclampsia decided to strike hard (and I was already rattling with pills – I was on 24 tablets a day!!!!! As I’m allergic to labetalol I had to take methyldopa 4×4 plus painkillers plus antisickness. Baby developed tychocardia and my liver bloods came back really really bad – I had proteinura since week 33. In the end I had it all, sickness, headache, blurred vision but also weird chest pains. I was put on a magnesium sulfate as an emergency and (instead of ccection – don’t ask…) I was carefully induced (I’m allergic to majority of anastetic drugs). I had a “late premi” with polycythemia and severe jaundice – so we’ve stayed in NICU for a while to get him better – he was massive (6lb7oz) and recovering well. Now my baby is 6 months old (corrected) and develops as normal. I’m pleased I can share a positive outcome – people rarely come back to share the good :-)

    Reply
  18. Thank you for this article! My results came back as 0.1 PAPP-A in our first trimester, pretty much as low as you can get, and it has us freaking out. That level, combined with me being over 35 gave us a 1:27 chance of Down Syndrome. NT was fine, HCG levels were fine. Luckily, a follow-up NIPT gave us some relief that our little boy doesn’t have one of the chromosomal abnormalities measured.
    Fast forward to 32weeks pregnant. I have placenta previa, so we’re monitoring that. He’s measuring small, so we’re monitoring that. The PAPP-A score puts me at risk for pre-eclampsia, so we’re monitoring that. It’s a whole lot of monitoring and “maybe something maybe nothing.” Hard to be living with so much uncertainty. And even with the NIPT results, I find myself anxious about false negatives or the potential for other chromosomal issues that weren’t tested. We opted out of an amnio because of miscarriage risk – we’ve been through the miscarriage thing once and didn’t want to tempt fate again. Keep your fingers crossed that I can post again in a couple of months saying that we have a healthy baby boy and that all this was nothing to worry about.

    Reply
  19. I suppose it is better to watch more closely those with low papp-a levels, but it is also very important not to create unnecessary stress. My papp-a was at 0.05 and I was at high risk for Edward’s sindrome. CVS came back negative and then it was just pure stress up until the delivery because doctors kept speculating what could go wrong. I had my baby boy at full term but they had to go for the C-section because he was too big for me, 4040 g. Other than that he was fine. He started crawling at 6, walking at 9 months and saying his first words around the first birthday. So, for me this screening test was an unnecessary torture. I started having panick attacks and I suppose that can’t be good for a baby either. Next time I will go straight to CVS.

    Reply
    • Thank you Tanja, positive stories are so encouraging. My PAPP-A is also very low, at <0.04, so hard not to worry, though NIPT screen result was also very low risk for chromosomal abnormalities. Hearing a story like yours will help me sleep at night for now!

      Reply
      • Hi Kali! My levels are exactly where yours were (extremely low .05.) can you give me an update on how everything went? Hope all is well!

        Reply
  20. Hi
    I have had two pregnancies with low papp-a they both ended in premature birth.
    The flow from the placenta was low with both of them. The second one also wasn’t growing as he should.
    The older one is 9 years old healthy and really active he was born in week 36 and was 2,2 kg.
    The younger one is 7 also healthy and active. He was born in week 34 and only 1,5 kg he spent 3 weeks at the hospital. He had no problems, needed no assistants to breath. Only needed to grow a little bit.
    I also have one 3 year old. in that pregnancie the papp-a was normal and he came at week 39 with c-section because he was sitting and they weren’t able to turn him. With my pregnancie history (that also includes still born) was decided to take no chances and do c-section.

    Reply
  21. Hello

    This is my first pregnancy and I’m currently 29 +5 with a baby boy.

    Tests revealed a low Papp-a of 0.3 and I had a Doppler ultrasound at 15 weeks no visible damage or anything wrong with the cord, doctors and midwives didn’t seem to be bothered.

    28 week (additional growth scan) at 28+6 revealed baby is on the higher percentiles and weighs a whopping 4lb already when we were expecting a smaller baby?! Supposed to see a consultant after but the hospital messed up and wrote that I had the additional scan as a result of my 31 bmi which isn’t correct it’s because of the low Papp-a ? So I’m none the wiser and waiting to speak to my midwife on Tuesday instead.

    No idea why baby is so big though.. GTT was normal .. at a guess maybe because I’m 5’10 & oh is 6’5?

    My blood pressure has always been nice and low also so now I’m worried of the other two possible linked Papp-a issues pre term and stillbirth ??

    Anybody had a bigger (off the chart) baby with Papp-a low?

    Thanks xx

    Reply
  22. My wife PAPP-A was 0.418 MoM and she in her 29 week of pregnancy have preeclampsia. Now is 36 week but since diagnosed preeclampsia have therapy with several antihipertensive medications.
    Esbach is right now higher than normal levels ( normal = <0.30; my wife's 0.41 g/L – begining of kidney damaging ). Baby is in good condition, don't have IUGR.
    We are waiting for delivery closely to full term, I hope so.
    Conclusion from our expirience : we have faced with preeclampsia and our PAPP-a was lower than 0.5

    Reply
  23. I am really satisfied with this posting that you have given us. This is really nicr work done by you. Thank you and looking for more posts.

    Reply
  24. I have low Papp-a and had to have a scan today at 35 weeks to check the growth. The lady carrying out the ulstrasound said it wasn’t her area of expertise (Papp-a) but baby is measuring as it should.
    My obstetrician told me at 12 weeks (when I found out I had low levels) that I need to take a form of aspirin and he started me on asterix which I need to take up until 36 weeks. Apparently it’s a new thing and not all gp’s are across it.

    Reply
  25. I was diagnosed with low papp a at 12 weeks . I did give birth 10 weeks early with no other indicators leading to what may have caused this. The only indicator was this low Papp A test .

    Reply
  26. I have just been told I have a Papp A of 0.28 the normal level is now 0.37 or greater. The midwife told me it was nothing to worry about as all my other tests were good. They will do a uterine Doppler test at my 20 week scan. If anything is wrong they said it is manageable and not to worry.

    Reply
  27. I had low Papp-a in both of my pregnancies. For my first I was considered high risk and had additional sonograms and non-stress tests up until delivery. Baby came at 39 weeks and was healthy although she had a small, flat placenta and a vilimentis cord insertion so her cord snapped during delivery. She was diagnosed with OI when she was 5 but otherwise is a normal healthy kid. Second child had same additional tests and monitoring. He came at 39 weeks and was perfectly healthy. All of the additional monitoring was great although stressful. Happy to say both babies were fine.

    Reply
  28. Hi everyone
    I was diagnosed with low papp value.. Midwife told me to take asprin.. But another doctor said its ok not to take tablet.. Ur fine… Results says chances only… My all reports were good untill i reached 28 weeks.. My tummy was seemed bigger so doctor found baby not putting on weight its bcz of excessive water… N closed monitoring started… I started feeling cramps 31 weeks but it was all fake.. Thn i was on bedrest.. So i should try to reach at 37 weeks… Which i crossed n i ate alot.. My baby finally put on weight bit… Still my body was not ready so i made decision to postpone delievery n went upto 40 weeks when they induced me… Experince was horrible… Its was trauma.. Placenta dettached at operation theature and thank god my baby came out on right time out.. I feel now it was purely my good luck… I lost alot blood… I will recommend to keep monitoribg ur baby movements.. Its not easy experience…. But stay positive mind.. I did lots of breathing exercise.. Believe me… I felt like it was giving fresh air to my placenta n kept it going until last day.. I was 1st oing it hours n hours… Now i think i was very innocent.. Was not much awared by doctors…my daughter is small in size but perfectly healthy n active… I know she will recover soon… I hope this info will help u

    Reply
  29. Hi Everyone, I had low papp-a with my first pregnancy. Preventive measures were weekly growth scans starting at 28 weeks and baby aspirin once a day. My son measured small at every growth scan and they came to the conclusion that I had IUGR(intra-uterine) growth restriction and I was induced at 39 weeks since he was no longer growing inside and it was better to have him out. Labor was smooth and easy and he was born 5lbs 4ozs 17 3/4inches. No issues and super healthy just small. He is 20 months old now happy and healthy but still on the small side which makes sense because I am tiny as well as my husband plus we went to gastro and endo specialist just to rule out any underlying issues. I am now pregnant again with a boy and I have low papp-a again. The doctors were surprised that I have it again. I am currently 26 weeks and will start my weekly growth scans in 2 weeks. I am not too concerned considering I experienced this recently and everything turned out fine.

    Reply
  30. Hi,

    I am 19 weeks and I just did the ultrasound for the 20 weeks, everything its perfect with the growth of the baby and the size. However, i have lower levels of Papp-A and I started taking 160 mg of aspirin at night because it is faster absorbed when taking at night. The doctors told me that i might deliver the baby after 36 weeks but i am going to the doctor every 2 weeks. We are positive that our baby will be ok, we are taking all the test that the doctor has recommend and hope for the best.

    Reply
  31. Bad news/Good news:
    Low papp-a with no abnormalities yet preterm labor at 26 weeks. Incompetent cervix and fully effaced with 1-3 min contractions. Hospitalized for 6 weeks and released at 32 weeks on strict bed rest at home with strict regiment of procardia q 6 hours. Miraculously carried until right at 37 weeks. Delivered a very healthy but sga baby boy vaginally (5.8lbs apgar 8/9). Low papp-a, in my opinion, does indicate some sort of abnormal issue in most cases. Best wishes for those searching for answers and for their unborn babies.

    Reply
  32. Hi everyone,
    We recently had our bloods back as low for papp-a at 0.0400 MoM (which seems much lower than some others) and low free Beta hCG at 0.3100 MoM. We opted for a CVS last week and were told today it was inconclusive as the sample didn’t have enough of the baby’s cells. We were thinking of the Panorama test but after reading so many stories on here of having that come back clear and then something going wrong still, I’m not sure what’s best. We have another scan this week to check for brain abnormalities but doctor didn’t explain why. Feeling very frustrated and confused about it all :(

    Reply
    • I had panorama at 14 weeks after a bad screen. No chromosomal abnormalities. It seems to me low papp-a is still indicative of some problem in a lot of cases. Mostly it would appear that the placenta or something other is an issue if chromosomal abnormality is ruled out. Mine turned out to be incompetent cervix in addition to something (undetermined) with placenta since baby was sga. He is a happy and healthy 3 year old now. I went through hell to get him here safely but worth every sacrifice. Best wishes.

      Reply
  33. I was told I had low papp a at our first scan. I don’t actually know what level it was but I had 5 additional scans with constant appointments after as my pregnancy progressed. I was put on daily asparin.
    I was allowed to go over my due date by 7 days and then I was induced. My boy was born healthy but smaller than other babies in my family at 6lb 1oz. Throughout the labour his heart rate dropped at each contraction and he was delivered with oxytocin and forceps to get him out quicker. I would love to have another child but am unsure if I am likely to have low papp-a again or what the level is linked to. Does anyone know? There seems to be no information on this, only on the affects of a current pregnancy. Best wishes for all mums to be out there, stay positive and try to learn your bump’s movements, this was a real reassurance for me that he was moving or that I was aware if he hadn’t for a while and I could call for a check up.

    Reply
  34. Hi Michael
    Thank you for putting up your article it was in some way reassuring to know that there is a possibility of having a healthy pregnancy and positive outcome after being detected for low PAPPA. I previously lost 2 sons in seperate pregnancies last year (2017) at 18wks and 20wks with no reason or cause found. The only thing they noted on the post Mortems were both had slight inflammation of their hearts.
    I’m pregnant again 16wks and have been told I have low PAPPA but all chromosomal testing is normal. Being High risk already from my previous losses they are going to monitor me closely but I can’t helo but wonder was this a factor in my previous losses and will this pregnancy end in the same fate now I’m been detected for this. I’m trying very hard to stay positive reading all the previous posts from ladies who had healthy full term births or others who did have early labour but resulted in healthy babies. I’m clingy to hope at the moment but it’s starting to waiver.

    Reply
  35. Hello, in 9+5w the doctor tell me, that i have a low papp-a level (0,379 mom). No i am 14+0 w and i am waiting for nipt. But i am still afrait of this level. In 13+2w my level of papp-a was 0.570 mom (in my firt pregnanci in thos week was 0.8 mom). Doctor said dont worry, but they do nothing. No adition controls, nothing. I am still breastfeeding my firt baby, maybe this level of papp-a i bacause that. But i still afraid. Sorry for my english, i am from europe. And thak you for this website!

    Reply
  36. hello everyone! thanks for sharing and thank you Michael for the article. It has been difficult to find something really informative online.
    I’m in France, with a low papp- (0.3 MoM) and waiting for my harmony results while biting my nails (1/100 for downs). This is my second and he/she came as a surprise. My anterior pregnancy was too normal and my little girl is 2 and half and I’m completely in love with her. This one is different because of bad timing really, and i don’t feel i’ve focused enough on my pregnancy (change of region and careers for the two of us.) I wonder if it is because i didn’t take enough pre-natal vitamins (just folic acid). I feel like is somehow my fault and turned the internet upside down looking for answers. So thank you and all the moms for sharing their stories, even when they are truly sad. I hope I’ll come back to you with good news. Good luck to the rest :)

    Reply
  37. I had low papp-a in my first and second pregnancy, I had ultrasounds done every 2 weeks after the 24 week with both babies. My first baby was born at 38 weeks 6lbs 8 onces super healthy babygirl! and my second was born premature at 35 weeks my water broke out of no where no contractions, my doctor said it had nothing to do with my papp- a levels since I had an ultrasound that week and the baby was doing fine, also he was born 5lbs 3 onces which is big for a baby born at 35 weeks so it seems like my placenta was working super good at delivering nutrients. He did spend 6 days in the nicu due to difficulty breathing it seems like his lungs werent quite ready. So if you have low Papp-a by all means go to your scans follow your Dr’s orders but please dont panic by what you read or other peoples stories and outcomes every pregnancy and every person is different just trust God and try to enjoy your pregnancy I know is hard but I know a lot of women who have had normal levels and bad outcomes, just stay positive and just like with every pregnancy healthy or not keep an eye on whatever doesnt feel normal to you! I do wonder if I have a 3rd pregnancy if I would have low Papp-a again or not? if anyone has had this experince please comment!!! Best wishes to all the expectant moms!!!

    Reply
  38. Hi everyone, I was diagnosed with Low Papp-A in 2013 with my son (my first) I’m in the UK, I went for my 12 week scan (including down syndromes/nuchal scan) and two weeks later got a letter saying I had to meet with a consultant at the hospital, who told me I had Low Papp-A and bluntly told me that I should prepare myself for a possible late miscarriage, still birth, preterm labour, preeclampsia or low birth weight baby (she wrote all of this in my pregnancy notes, my midwife was horrified!) I was told I’d have two growth scans one at 28 weeks and one at 34 weeks. My pregnancy was absolutely fine all scans were good, my last growth scan they estimated my son weighed approx 5lbs (At 34 weeks) I went into labour the night before my due date, but my labour started by me passing some blood clots, in which I went straight to the hospital. I ended up having a quick labour and my son was born on his due date weighing a small 5lb10 at full term, my placenta was a third of the size it should of been, was a grey colour and had a hole in it (they said it may have started to detached itself which caused me to go into labour and hence the blood clots) the midwife who delivered my son said I was really lucky to have go into labour when I did, and I didn’t ask what she meant by that but I knew by the look on her face. Afterwards now knowing how lucky I was with my son I know how important it is for much closer monitoring towards the end of the pregnancy with Low Papp-A. I since then have gone on to have a healthy little girl in 2016 (no Papp-A diagnosed) and am currently pregnant with our third and am anxiously waiting the results
    Xx

    Reply
    • Hi, just wondering if you know your papp a levels yet? I’m considering a second child and wondering if my level will be low again. Best of luck to you and yours

      Reply
  39. hi everyone I just got my test answer is PAPP-P 5.426. I’m start to worrying. What does it mean? Most of yours seems low. I did not read any high result. Sorry I’m not native speaker so please explain simple words. I’m feeling tummy getting harder when I see this answer. I’m 12 weeks now. is someone here now? Please answer

    Reply
  40. Hello everyone and thank you for this article and posts, as I have only read through very select articles on google search. I see that low PAPP-A can go either way, but either way it raises a flag. I was called today so innocently accepting the news that my pappa level is low .2 everything else seems normal and I’m 12 weeks. I immediately googled what in the world is pappa? So 2 hours later, here I am posting behind all the stories…all with different conclusions. This is my 6th pregnancy, with 1 live birth to my son who is 4. He was born oversees where I wasn’t offered screening tests. So this is all new to me. I’m in touch with my doctor to find out how being higher risk will be handled over the course of my pregnancy. I hope to update you all soon.

    Reply
  41. Thank you so much about this article! All happy stories gives me hope. I just found out I have very low papp-a, I haven’t had ultrasound yet. I have has mc and one down pregnancy so (whew papp-a eas ok) so I’m little bit confused right now.

    Reply
  42. Hi Everyone,

    Its a ray of hope to find this article at the peaks of my tension and confusion. I am from India, aged 33 and is in my second pregnancy. I have a very healthy and intelligent 3 year old girl from my first pregnancy. In my current pregnancy at 14 weeks, NT scan looked fine. But the Double marker blood test shows the following results.
    HcgB : 1.45 MoM ,
    NT 1.16 MoM,
    PAPP-A :0.21 Mom

    Baby’s growth is excellent and on dates for GA.

    But the result showed screen positive for Trisomy 21(Down Syndrome) as 1:194 which is unbelievable as we had a healthy first pregnancy and no history of downsyndrome at mine and hubby’s families.

    OBG suggested me to go for CVS to confirm on any issue but we are completely against this test as it is an invasive procedure and risk of miscarriage is high. I am very sure that 1:194 is just a risk possibilty but not the actual risk. Me and hubby are not willing to get any invasive procedure as the risk of 1:194 is not something to be worried.
    Please suggest whether its good to go for CVS or We will proceed further without any second thought.

    Reply
    • Hi Prathima,

      I’m sorry to hear of your situation, I completely understand how you are feeling. What did you decide to do in the end?

      I had a CVS yesterday after we had a 1:21 trisomy 21 risk. I booked for a Harmony test privately as it’s not on the NHS here till next year- do you have this test in India? It’s non invasive – just a blood test and is very accurate. It is £400-£500 here so not cheap.

      At the appointment I was devastated that the lady who did the scan beforehand advised that we didn’t run the test because she was seeing major heart defects and concluded that our baby is ‘incompatible with life’. Obviously we are heartbroken and decided to go for the CVS just to be sure of the full picture. We spent yesterday at UCH in London for the CVS and saw a fetal cardiologist sonographer and he concluded the same, but also said there are many markers for chromosome problems too. He said he had never seen this heart defect before and likely the baby would not survive life/be treatable. We will hear tomorrow hopefully on our results but are not expecting good news.

      I hope you had better news.

      My hormone levels were:

      HCG: 1.20
      NT: 2.5mm actual measurement (1.72 MOM)
      PAPP-A: 0.47

      I’m 35 and have had one healthy daughter who is 2.

      Reply
    • Dear Prathima,

      I am sorry for the ordeal you are going through. I can very well imagine as I went through similar thing in my first pregnancy.

      I have privately done the Harmony test and came out as low risk for all 3 Trisomies. I let the hospital do the combined test as well and due to a law PAPP-A of 0.21 my Risk for Downs increased. The hospital suggested CVS which we decided not to do as we were happy to relay on the Harmony results. We ended up having a healthy 4kg boy who was born 39+5. This goes to show that low PAPP-A does not have to lead to complications or a negative outcome.

      I am expecting again and am 13 weeks pregnant and my current PAPP-a is 0.44. My doctor advised me yesterday that PAPP-A above 0.3 is no longer considered low. The cut off is the 0.3 level.

      I would strongly suggest Harmony or NIPT as know is some countries- it does cost £400-£500 however in my mind much better option than CVS.

      Wishing you good luck!

      Reply
  43. I am 46 years old and having my second child. Given my age we had every scan in the book. We had no chromosomal abnormalities, but a low Papp-A. I’m now 36 weeks and counting and my daughter is 6lbs and gaining in utero. Having worried myself sick in my first pregnancy at 43, I’m not going to do that this time. I’ll let you know how it goes.

    Reply
  44. I had low Papp-a with both my boys. The first was born at 36 weeks (5lb 15) and healthy, home the next day. The second I suffered a placental abruption, was rushed in and they got him out before I could even blink! Quick work saved his life – was 34 weeks and some difficulty and long stay in special care but now crazy little 2 year old. The best advice is stay positive and stop asking google! I appreciate every day how lucky I am for his survival

    Reply
  45. Thank you so much for the article and all the stories. I feel like I am still searching for answers. I had low Pappa (0.3) at the 12 week check. Scan was good, bub looked healthy and happy. But overall result was worrying because of the low hormone levels. We had a panorama screening done and results came back very low risk, baby chromosomal typical. Four days later, I started to bleed and after investigation there was no heartbeat ?? bub had passed.
    Keep wondering if there was something we could have done or if we should have followed up on those hormone levels. Doctors just seemed so unconcerned especially after the panorama results.
    We are still awaiting the placenta and fetal tissue test results..
    from these posts it just seems that sometimes it works out and sometimes it doesn’t ?

    Reply
  46. I have had three children and had low PAPP-A with all three pregnancies. Each time, we found out after the 13-week scan that the PAPP-A level was low, so they had us come back at 20 weeks and then every 4 weeks until delivery. All three of my babies were born at term and healthy, although their sizes varied a lot.

    My oldest was born at 39 weeks 2 days, was 7lbs even and 18.5″. By 24 hours old he was only 5lbs 14oz because I’d received so much fluid during labor that he had a lot of water weight. He’s now 5 and 85th percentile for height.

    My middle son was found to have a two-vessel cord at 24 weeks, and that can also be associated with heart defects and SGA. We had a fetal echo which revealed normal heart function and anatomy. He always measured large (>97th percentile) and was born at 38w6d at 8lbs 5oz and 20.75″. He’s now 2.5 and is only 13th percentile for weight but is perfectly healthy aside from allergy-induced asthma and some food allergies (unrelated to the PAPP-A).

    My youngest always measured on the smaller side at her scans, and at 28 weeks was small enough they considered increasing the frequency of our growth scans because she was nearing the lower limit of normal size. She rebounded and from 32 weeks on measured about 25th percentile. She was born at 40w1d at 7lbs 1oz and 19″. She’s 10 weeks old now and 12.5lbs.

    Our perinatal specialist said they still don’t fully understand the role PAPP-A plays and how lower levels associate with certain risks, but I’m thankful our close watching was all they needed.

    Reply
  47. I had low Papp-a and was very scared when I received the results. I am 36 so I was already seeing a Maternal-Fetal specialist due to my age. I had to see him every four weeks for an ultrasound once the test results came back.
    Unfortunately my blood pressure started to rise at each OB appointment. My doctors said that women with low Papp-a sometimes develop preeclampsia. I had read that baby aspirin was beneficial in preventing or lessening the effects of preeclampsia, so I started to take it. I do think it helped. Even though my blood pressure was high, I was still below the dangerous levels of protein in my urine and having elevated liver enzymes.
    However at week 35 my blood pressure sky rocketed and I was admitted into the hospital. My protein and liver enzymes were starting to elevate as well. We all made the decision to deliver my son. He is very healthy, but was small at birth- 4 pounds 13 ounces. The ultrasounds always measured him much larger, so I’m relieved that they delivered him when they did. My amniotic fluid was also decreasing- another placental issue. My son wasn’t growing adequately in my body anymore. The doctors believe this was all tied to the low Papp-a. My placenta only grew to maybe 75% and couldn’t sustain my son anymore.
    My son is thriving now. He is two months old and almost 11 pounds! My blood pressure was high for a week after delivery, but is back to normal. The doctors had placed me on blood pressure medicine and bed rest at week 32. I am no longer on the medication or on bed rest.
    Overall I am a very healthy woman, except that I had been significantly Vitamin D deficient (17) the year before I became pregnant. My cousin-in-law found out that she had low Papp-a, too AND she was also significantly Vitamin D deficient (18). I am convinced that Vitamin D had something to do with the low Papp-a. It’s just too coincidental.
    Best wishes to all of you who have low Papp-a. My best advice is to take the baby aspirin, prenatals, Vitamin D drops, extra calcium and magnesium, eat a healthy diet, go to all of your OB appointments and get monitored by a specialist every 4 weeks. I honestly think that I would have had to deliver much earlier hadn’t I taken care of myself so well along with the constant doctor monitoring.

    Reply
  48. I just got the news that my PaPP -a levels are 0.08MoM and I am freakung out. We did the blood work for theHarmony test today but that can takeup to 4 weeks. My HCGwas 0.4 MoM. I am freaking out.

    Reply
  49. Hi Michael
    I found this very interesting reading and read all if the stories prior to given birth two weeks ago.
    I had my baby girl at 35 weeks after being induced. She was a healthy but small 4lbs4oz.
    I was also diagnosed with low PAPP-A levels at 12 weeks screening for Downs.
    I was offered extra growth scams because of this.
    From around 29 weeks I measured small on the graph and my consultant got increasingly worried. At 34 weeks I was given steroid injections to mature baby’s lungs just in case..
    At my final scan at 35 weeks the fluid had decreased and my consultant didn’t want to take further chances.
    Baby Siân is amazing. She didn’t need any help with feeding or breathing. Her blood sugar was fine and her body temperature was stable. The staff could not believe how well she coped.
    We stayed on ward for 4 days then went home.
    She’s a little star.
    Just want to post my story so others with low PAPP-A levels can remain optimistic
    I think close monitoring is the way forward.

    Reply
    • Wow! We had a very similar experience!! I just posted my story. I’m glad to hear that everything is going well now:)

      Reply
  50. Hi my daughter has been told she is low on Papp -a she is 14 weeks and it is her second baby she had preclampsia with her first baby and was poorly afterwards with HELLP syndrome I am feeling a little concerned she is on aspirin and having another scan.

    Reply
  51. Hi am Priya, am in my 13th week of pregnancy. I am having 0.35 PAPP and i am having fear about my baby and my deliverey. How to increase this PAPP level? Can anyone please advice?

    Reply
    • Hi Priya,

      Unfortunately, it is not possible to increase your PAPP-A levels, at least, not that I am aware of. Your doctor can tell you what is and isn’t possible, but based on the experience of many women who commented (and studies), low PAPP-A may not negatively affect you or your baby. Good luck!

      Reply
  52. Congratulations on the birth of your child!!!! I’m happy to hear mom and baby are doing well. I am currently pregnant with baby #2 and I’ve had Low PAPP A Levels with both kids. My daughter was born at 29 weeks 2 days (10 weeks and 5 days premature.) Weighing a small 2pounds 2oz with breathing problems. She’s 2 yrs old now and is healthy despite having Chronic Lung Disease from prematurity. After birth I heard the doctors say the placenta was too small and was not allowing her to grow. Now with my second child I’ve been put on a daily low dose aspirin to control having PreEclampsia during this pregnancy. I was told my second one would come early I’m just pleased that it wasn’t as early as my daughter. I am however extremely small like I was with my first. No one could tell I was pregnant and although I’m almost 9 months I don’t look a day past 5 months along. Best wishes and blessing to all parents experiencing this during pregnancy

    Reply
  53. I am 18 weeks pregnant. I underwent genetic testing at 11 and 15 weeks, my results were normal exept for low Papp a levels (mine was 0.23MOM)
    I had a few instances of bleeding, the last one was less than a week ago and I also have frequent headaches. I am not sure if
    it is related to the low pappa, my doctor said that it’s not.
    It is frustrating since my doctor did not answer any of my questions, she said I should probably choose another doctor.

    Reply
    • Fast forward 10 months… At 20 week US I found out that the baby had a major birth defect. We decided to end pregnancy at 23 weeks. Bleeding and low paap a was the only indicator that something was wrong

      Reply
  54. This is one of the first articles I read when I was diagnosed with low papp-a, as I wanted to know everything I could, I spent hours googling things. This article was very informative and I really loved it, but a lot of the comments scared me. I was diagnosed with low papp-a (.20) at 14 weeks with my 3rd baby (I did not have this test done with my previous pregnancies). Beginning at 28 weeks I started receiving extra scans every other week just to check blood flow in the placenta as well as baby’s growth. Surprisingly baby boy was always in the 90th+ percentiles and growth was on a good curve and not fluctuating. At 36weeks + 1 my water broke in middle of the night and I delivered a healthy baby boy 6 lbs 6 oz (which is a fairly big baby for 36 weeks) withth zero complications and no NICU time. I had a perfectly normal pregnancy the whole time as well. My doctor does not think my water breaking/premature delivery had to do with the placenta. I just wanted to post my success story so when others come looking for answers I can give them hope that a low papp-a diagnoses does not necessarily mean loss or complications! Good luck everyone!

    Reply
    • Thank you so much for this story! I am 15 weeks with my first and have levels of .005 (1 in 5 chance of trisomy) and we are very very worried. My scan turned out great but we’re waiting on more blood test to come back to look at the chromosomes. Thank you for inspiring some hope as some of the other stories are really scaring me.

      Reply
      • Hi Rebecca,
        I just got low PAPP-A results (0.23) which put my risk of Trisomy at 1:133.
        I’m curious to know how your blood tests came out.
        I did my NIPT tests yesterday so it’s a 1 week agonising wait.

        To all who have posted, it has been quite reassuring reading your experiences and outcome. It has armed me with both hope and knowledge that I can go back to my GP /midwife with more probing questions .

        I wasn’t out in high risk if offered more monitoring or even told about the risks of preeclampsia or preterm labour as a result.

        Thanks again all, for sharing.

        Reply
      • Hi Rebecca,
        How did you go with the rest of your results?
        My PAPP A came back at .06 with a 1:2 Tri 18 and 1:40 Tri 13.

        I was prepared for a high risk for Downs as I had this with my first but not my second. This pregnancy also low risk forbid Downs.

        My first came at 34 weeks and second at 37. They were born in Australia. I born live in the UK and not being familiar with things is also stressing me out a little.

        I’m booked in for an amnio in two weeks, I will be nearly 16 weeks.

        So overwhelming as scans are fine.

        Fingers crossed.

        Reply
  55. I was diagnosed with low papp-a in my second pregnancy. I received this piece of information along with very ominous predictions of future pregnancy outcome on the phone. I cried, read articles online, and cried more. The biggest concern, the way I understood it, will be grown restrictions and potential premature birth. And then I came across this article. It didn’t calm me down completely but it gave me hope that the outcome can actually be positive.
    Long story short, two weeks ago I was induced at 39 weeks and 3 days because the baby looked big during sonograms. I delivered a healthy baby girl at 9 pounds 4 ounces. I am extremely grateful to the author of this article whose information I found comforting during a difficult phase.

    Reply
  56. I was diagnosed with low PAPP-A around my 20 week mark. OB said it was nothing to worry about and I was sent for growth scans every 4 weeks. She mentioned that this condition does cause issues with the placenta near the end of pregnancy and that she wouldn’t let me go past 39 weeks so I would be induced by then as she feared the possibility of a still birth.
    All was fine and normal until 35 weeks, 2 days when I woke up bleeding. I rushed to the hospital to find out I had placenta abruption, which is where the placenta either completely or partially detaches from the uterus. Baby was fine so they proceeded with normal labour and vaginal delivery. I gave birth to a healthy 5 pound 10 ounce baby girl. She stayed in the nursery for about 7 days. She is now 9 months and thriving. The OB said she was certain this happened from the low PAPP-A.

    Reply
  57. wanted to write on your blog because last year my husband and I came across it and it gave me some hope. Everyone kept telling me that most people with positive outcomes don’t take the time to write, and that is definitely true…they just go on with their lives, but I know having gone through EXTREMELY low HCG and PAPP-A results TWICE, reading people stories can be helpful…

    January 2014 I received my 1st trimester screening showing very low HCG and PAPP-A with a 1 in 3 for Trisomy 13/18. Sono seemed fine at that point, baby was always a little small, but nothing alarming (I was born full term at 5lb 7oz, so we all just assumed I too would have a small baby). My panorama came back “inconclusive” which I later learn is cause for alarm in itself because there is not enough of the baby’s DNA in my blood stream to give a reading. My Harmony came back OK. Long story short after a failed CVS I went to a new specialist desperate for answers a month later where we learned our baby had passed away on February 16th 2014. It was a huge relief believe it or not at this point… because it had been a month of no sleep, no eating, no work, just anxiety for my husband and I. We were getting NO WHERE and I was fearing I needed to make a decision soon, but God or whomever made it for us. We decided to submit the fetus from my D&C for testing and learn the baby had Triploidy, an even more rare chromosomal disorder than the Trisomy 13 or18 we assumed it was (which Harmony does NOT test for FYI). It is typically caused by two sperm + 1 egg and a complete fluke! We were told by several specialists having that happen again to the same couple is like getting struck by lightning twice.

    After recovering and grieving some, I became quickly pregnant again that May. Excited but terrified of going through this all over again (despite the odds in our favor)…Well once again on our 1st trimester screening we received almost identical levels! 0.09 MoM PAPP-A and 0.12 hCG and this time even our AFP was low at 0.15MOM! We could not believe it! Except this time our Panorama came back perfect…we were having a girl! We did not mess around this time and went to the best specialist in our area who did a complex 4D sono and examine all of our baby’s organs and growth which were all consistent in the 40th percentile and seemingly healthy. I did an amnio at 17 weeks with soup to nuts DNA testing and all came back PERFECT! A huge relieve, but not the end. The remainder of my pregnancy I received biweekly monitoring and at the end of my pregnancy weekly and eventually daily. I NATURALLY gave birth to a perfectly healthy 6lb 1oz baby girl the day before her due date February 10th 2017 (almost a year to the day our baby boy passed)! No doctor has any answer as to why my levels were so low… So I am an example of someone who has had both a happy and sad ending to these terrible test results, but know there is hope and if your baby is healthy, then you have to stay healthy for him/her. So stray strong Mamas and Papas!

    Reply
    • JoThis is my second pregnancy. My first ended on December 11th, 2016 when I gave birth to the most beautiful angel, my son. He was born prematurely at about 21 weeks due to an infection. In that pregnancy I had many issues which involved bleeding/clots at 6 1.2 weeks, 14 weeks and 17 1.2 weeks. Eventually this subsided, but at my 20 week scan things got a little unimaginable. I had extremely low fluid, which resulted in my old doctors telling me everything looked fine as of now, but unfortunately about a week and a half later I delivered my son in my home, in my toilet. I had a long recovery. I also have a partial septum in my uterus (which was confirmed through laparoscopic surgery after delivering my son, but is found to be very flimsy and muscular). It was not sought out to be the cause of all of these issues, but my OB and after consulting with an MFM distinguished it didn’t seem like a healthy pregnancy to begin with. No matter how big my son got or his heartbeat being strong.

      I am currently 13 weeks pregnant, I am due February 22nd, 2018. I must say everything in this pregnancy is going extremely well. No bleeding whatsoever, at my 11 week and 5 day ultrasound my baby was measuring 12 weeks and 3 days, which was absolutely breath taking to me; heartbeat was 167. I had my First Trimester screening done and everything came back absolutely perfect, Everything that needed to be formed is formed, NT was all normal, brain looked beautiful. EVERYTHING! Except I received a PAPP-A level of 0.15 and the lady who called me freaked me out. I already am being monitored as high risk, due to the issues in my previous pregnancy, but at first I was extremely worried, but my doctor eased them. Starting at 14 weeks I will getting cervical length measurements every 2 weeks. Starting at 16weeks until 36weeks I will get progesterone shots and now with PAPP-A results I am currently taking 81MG of baby aspirin daily.

      How is it everything could be so amazing and going so well and then this. in the discussion

      Reply
    • Sorry, everywhere I wrote 2014 should be 2016…but you probably figured that out! The result of a sleep deprived Mama! :)

      Reply
  58. Our PAPP-A reading was 0.3 and I was being monitored by the Placenta Clinic in Manchester, UK with very regular growth scans from 17 weeks onwards. As predicted, in the third trimester at around 34 weeks, our little boy (also called Lucas) stopped growing and then at our 36 week scan, it was decided by our consultant to induce me straight away. Lucas was born weighing 4 pounds 11 ounces at 36 weeks- the weight of a 33-34 week baby but now 4 weeks later, is now 5 pounds and 15 ounces and is doing wonderfully. Low PAPP-A is certainly a marker but according to my consultant, doesn’t always mean there is a negative outcome, but I feel that close and constant monitoring is the way forward for low PAPP-A mums to help as many difficult pregnancies as possible.

    Reply
  59. Hi,
    My daughter was born at 31weeks, no reason could be found. She is a happy thriving 3 year old now. Only slight abnormality was a low PAPP-A (0.28). I am pregnant with baby no 2 now and PAPP-A is 0.22 this time round. Having looked at studies on prem babies the likelihood of a preterm Labour after one with no reason is increased and I have only managed to find studies that link low PAPP-A to preterm/low birth weight in 50% of cases. Would love to have a read of the study that shows no proof if you could let me know where it is please

    Reply
  60. Currently 14 weeks pregnant with identical twins. this is my third pregnancy. They first two were easy and without issue (except for some high blood pressure towards the end of my first pregnancy contributed to being 9 months pregnant and my sister getting married).
    I was just told my chromosome testings are all normal. Heartbeats are both strong and babies are both growing at steady paces (we’ve gotten ultrasounds every 2 weeks since week 7). However, my PAPP a level was low. I’ve been trying to do some (smart) research. I appreciated this article. It was practical and helpful, without sending my blood pressure skyrocketing.
    My doctor explained that for now, the levels just meant they would be watching me extra closely. Since we are having multiples, we will also begin to see a perinatal specialist next week (also standard for multiples).
    Again, appreciate the article and thread.

    Reply
  61. My daughter is 28 weeks and baby is measuring very small she was told she has low PAPPA at the 15 weeks she is having scans every 2 weeks . They have told her worst case baby could die inside her which has scared her a lot. She has her next scan on the 20 th of this month baby is 21.6cm at the minute and has the tiniest bump ever. Can anyone help our stress

    Reply
  62. Thanks for writing this. Just got told the same thing but only a little low. No one is terribly concerned so we won’t be unless we get told otherwise. Really nice to read something that is based on real studies!

    Reply
  63. Hi I had low Papp-A levels detected in both of my pregnancies. Both times I developed pre-eclampsia and iugr and around the same gestation at 33 weeks. My first pregnancy, the Papp-A was never even mentioned and I was not monitored for anything until my body starting having pre-term labor contractions at 33 weeks. I discovered the low Papp-A link to preeclampsia and growth restrictions on my own after I saw it was marked as low on the report for my second pregnancy and discovered it had also been marked low on my first. Both babies were born early, one at 37 weeks and one slightly under. They were inductions due to the complications that I was having. Both babies were very small, both in the four pound range. Both placentas were very small as well. The first placenta was 183g the second was around 230g. A normal placenta is between 500-600g. I am pregnant again and am expecting a similar outcome. But I am only 5 weeks. I am happy to hear that your little one is doing so well.

    Reply
  64. Im so glad that I ran across this article. This is my 3rd pregnancy (I have 2 healthy children Aiden (6) and Johrnie (3)) and this was the first time I ever experienced something like this. My 1st trimester screening screened for DS and Trisomies as well. The levels were elevated and there was a concern with my PAPP-A as well. The worst part is that I feel like the specialist treat me like a guinea pig and have even said that I am the “perfect storm” (whatever that is suppose to mean). At my 18week appt the baby’s femurs were measuring small but babies grow at their own rate.

    Anyway, this has definitely put my mind at ease a whole lot as each pregnancy and delivery is different. I had Aiden at 39 weeks although I had to be induced due to PB issues he was 5lbs 10.9 ounces and is perfectly healthy. I carried Johrnie to term (she was actually 1 day past her due date lol). She had to stay in the NICU 9 additional days because she swallowed fluid and the cord was wrapped around her neck which resulted in her having pnuemothorax which later resolved itself. She was also small at 5lbs 11oz.

    Again, thanks for sharing your story.

    Reply
  65. Hi there,

    In December 2016 my son was stillborn at 30 weeks. I had borderline low PAPP-A levels in this pregnancy (0.34 MOM) with no other complications. I saw a specialist regarding these results and after a very lengthy ultrasound and uterine artery doppler it was determined that the function of my placenta would be fine to carry my son to term. We were given a clean bill of health and sent back to our midwives. 1 week later at a routine midwife appointment there was no heartbeat and our baby had died, just days after the ultrasound revealed no placental complications.

    However, the results of the placenta pathology came back indicating that our baby suffered from fetal-maternal hemorrhage. This is a condition where a large amount of the baby’s blood passes from the placenta into the mothers circulation, leaving the baby anemia. Ultrasounds were not able to diagnose this blood transfer, but testing can be done to see if the baby is anemic. As well, a KB blood test can be done to detect the amount of fetal blood in the mothers circulation.

    While I know fetal-maternal hemorrhage is not very common, I would seriously recommend having baby checked for anemia at various stages in the cases of sub-optimal PAPP-A levels. I am not a medical doctor, but talking from the experience of a mother that needlessly lost her child. In my case, my PAPP-A levels were the only indication that somethings wasn’t quite right.

    We are currently pregnant again, and our PAPP-A levels were 0.8 MOM at 11 weeks 2 days. I believe these numbers are fine, but I would have liked to see them at 1 MOM. Hopeful for the future :)

    Reply
  66. I was diagnosed with low Papp-a and had weekly monitoring (ultrasounds and now-stress tests) beginning at 32 weeks. Thankfully I delivered a healthy baby girl at 39 weeks. My OB told me not to be concerned once this was discovered and that she just wanted to be proactive with the monitoring. Our goal the whole pregnancy was for her to grow and us to make it to a healthy 39 weeks. I was certainly very stressed over this, but am happy to say we achieved our goal and have a healthy baby girl!

    Reply
    • Im 11 weeks pregnant and just been diagnosed with a low Papp -a. I Have been trying to find information on it and can across this thread.
      I notice many people mentioning they did an NIPT test and holding faith in the results. I had one of these done for my previous pregnancy which came back all clear but in fact was incorrect as I miscarried my boy at 14 weeks as he had trisomy 18.
      So don’t be putting too much faith in those non evasive tests.

      Reply
  67. I had low papp-a I had my daughter at 34wk 4lb 11oz she was in SCBU for 13 days and is a perfectly healthy 5 year old who is ahead of most milestones. My son is 3 and at my 12 week scan had a 1 in 20 chance of downs according to my result he was 4 week early and 6lb 8 . I had cvs and confirmed healthy biy at 13 weeks. I hated every minute of pregnancy because of all the worry and stress but have 2 perfect children x

    Reply
  68. I was just told that I have low PAPP-A levels. I’m 16 weeks. My OB told me not to worry, though she did inform me of possible complications. For now, she says that it just means that i need to be monitored a little more closely.

    Reply
  69. I had low papp-a but because my measurements were ok at my 20 weeks scan it seemed to just be forgotten about yet if the measurements were small I would have been referred to the placenta clinic. Unfortunately my babies heart stopped beating at 26 weeks and I had a still birth. The cause of death was recorded as low papp-a and my placenta when delivered was small and abnormal. Our little girl was perfect. So please anyone with low papp-a please make sure you are monitored closely as sadly it can have consequences.

    Reply
  70. I also had low papp-a during pregnancy . I had various grow scan, my last one was at 35 weeks which the midwife said he lost weight and I should worry as all would be confirm on the next scan @37wks. After 3 days I start to loose my water went to the hospital and after 3 days (35wks and 6 days) my baby boy ( Lucas too) was born.
    Now I ask myself – what was the cause? As I was healthy? Does my baby boy will have grown dificultis now ??
    Nobody could explain to me why my water broke so early.

    Reply
    • Hi Lidiane!

      I know how frustrating it is not knowing what caused the premature delivery but I wish you all the best and good health to your Lucas!

      Our baby-boy turned 1 year (corrected) today and we celebrated with a Paleo chocolate cake that he ended up having all over his face :)

      Cheers
      Michael

      Reply
      • Can anyone tell us what happened to pregnancy outcome of those with low PAPP-A?

        I appreciate your kindness

        Reply
  71. Vidya:

    You are asking for specific medical advice. I would recommend requesting a consultation with a Maternal-Fetal Medicine specialist to review your very appropriate concerns.

    https://www.smfm.org/members

    Please let me know if I can be of further assistance.

    Reply
  72. Hi all,

    Today I went to hospital for my sister 5th month check up. Today our docter recognized that she is having low PAPP-A level of 0.35 .
    We both worried a lot ..kindly help with this . Our doctor gave aspirine tablet,some vitamin d capsule,accu Cal capsule,and some iron tablets..

    Kindly let us know whether this will not lead to anymore problems once we started diagnosing it.

    Reply
  73. Ruth:

    Multiple comments:

    1. The amniocentesis screens for chromosomal abnormalities. It can also screen for some genetic disorders depending on the indication for the procedure. You can have a growth restricted baby with a normal amniocentesis. So you were clear for the reason you had the amniocentesis.

    2. The low PAPP-A is a risk factor for Down syndrome but in some patients it can be a marker for poor pregnancy outcome (low birthweight, preeclampsia, etc.).

    3. You did not have preterm labor, therefore you do not have an increased risk for prematurity. You were delivered early because your baby was in trouble. Your pregnancy had reached a point in which your baby was going to do better in the NICU than in the womb.

    4. In a few patients, this issue of low PAPP-A, low birthweight, etc. can happen again in a later pregnancy. A consultation with a Maternal-Fetal Medicine specialist would be advisable for any future pregnancy. You should still have the first trimester screening. If the low PAPP-A were to be present in any later pregnancy, it could help your doctors determine your level of risk.

    5. Please note that in many patients the low PAPP-A can be a “one pregnancy problem”. It is not a contraindication to try again but before doing so, get a preconceptions consult with the M-FM doctor to go over all the potential risks.

    Reply
  74. Viki:

    Ask your Ob/Gyn to refer you to a board certified Maternal-Fetal Medicine for a consultation regarding the low PAPP-A. Where are you at?

    Reply
  75. my 12 week bloods came back with high risk for Downs, we had Amnio and all was clear (or so I was led to believe). Had 20 week scan, all ok. I was booked in for growth scans due to high BMI and at 28 weeks it was discovered that my baby was very small. It was then they advised me that in fact the flag for Downs was due to Low Papp-A…. I was monitored constantly for 2 weeks and eventually my baby was delivered at 30 weeks weighing 835grams!

    I’m pleased to say nearly a year on and he’s doing so well! We will forever be grateful to the person who booked me in for growth scans – the alternative doesn’t bear thinking about.

    What i’m interested in, is it likely to happen again on my next pregnancy? According to the nurses in NICU if you’ve had one prem, it’s highly likely to happen again. But then a midwife doubted that, as I never actually went into premature labour and it was in fact my placenta that was the issue.

    Just wondered if anyone has any info on future pregnancies?
    Thanks
    Ruth

    Reply
  76. My doctor told me I have 0.2 PAPP-A, it’s extremely low :( ,
    I am just 14 weeks ,
    I have one healthy son and had one miscarriage as well ,
    Do not know what to expect , just crying…

    Reply
  77. In medicine, we have diagnostic and screening tests. The diagnostic tests are more more expensive, invasive and could lead to procedure-related complications. They are thought to be conclusive for the presence of a medical condition. They are highly impractical to be applied to the general population. They are usually ordered for patients who have had either an abnormal diagnostic test or the presence of multiple risk factors for the condition or disease in question.

    Screening tests are usually inexpensive, easy to perform, not associated to test-related complications and recommended as a test to be performed in the general populations. These tests are supposed to have a high sensitivity and specificity but suffer on their predictive values.

    An example of the above is the Pap smear. It can identify pre-cancerous or cancerous cervical abnormalities. Depending on the type of abnormalities detected on a Pap smear, a diagnostic test could be a biopsy of the cervix, or even a more invasive surgical procedure. As you can see, this is an excellent example of how a diagnostic test would be highly impractical as a substitute to a screening test.

    What is the main limitation of screening test? The false positive rate, meaning the likelihood that the test would be abnormal in the absence of a problem. Back to the example of the Pap smear, many ladies will have abnormal Pap smears during their life but very few will have actual cervical cancer, but still we use Pap smears universally for the cervical cancer screening. The incidence of death due to cervical cancer is currently just a small fraction when compare to what it was before the availability of the Pap smear.

    Now, back to the PAPP-A, it is part of the serology component of the first trimester screening which is used for the risk ascertainment of three trisomies (13, 18 and 21). As outcome data accumulated, researchers realized that in a subgroup of patients with a low PAPP-A (<5 MoM) and/or low freeBHcG (< 0.5 MoM) would be at an increased risk for perinatal complications including gestational hypertensive disorders, fetal growth restriction and other conditions suggestive of "placental problems". Some of these patients also do have abnormalities of uteroplacental blood flow which can be detected by Doppler interrogation of the uterine arteries. The frustrating aspect of the issue at hand is that although low PAPP-A and/or low free BHcG can be used as a screening test for a poor pregnancy outcome, we can not further evaluate such patient with a diagnostic test which will then identify those that for sure will get into trouble, hence the recommendation of serial sonography for monitoring of fetal growth and other parameters.

    Of interest, in England and other countries were the first trimester screening is also offered, as part of the report they not only provide a risk assessment for a trisomy but also a risk assessment for poor pregnancy outcome as suggested by an abnormal PAPP-A and/or free BHcG (abnormal analytes).

    Bottom line, this is all a risk vs. benefit analysis which also should include a cost determination. Back to the Pap smear protocol example, we know that the cost related of these screening and diagnostic tests are completely cost effective and justifiable and clearly live-saving. Maybe in the near future we'll have increased accuracy for the detection of patients at an increased risk for an adverse prenatal outcome, but we should not ignore current abnormal reports on the basis of "a friend who had similar results and everything was fine".

    Footnote #1: All tests do have accuracy, specificity, sensitivity, positive and negative predictive values. There are well established ways of calculating all of these parameters. All of these parameters can have completely different results based on the incidence of the disease that is under consideration. These concepts can be challenging to understand, even to healthcare professionals. Misunderstanding of these concepts can lead to a lot of pain.

    Footnote #2. Biological variability. Not all small people are dwarfs. Not all tall people suffer of giantism. We all nature's manifestation of a Gaussian or normative distribution ("Bell-shaped curve"). The performance of a screening test will depend on the arbitrary assignment of a limit or "cut off" in the Gaussian distribution. So, if we have a Gaussian distribution of adults' heights, people who are under the second or third standard deviation from the mean will include plenty of normal short people but also the majority of skeletal dysplasia that cause dwarfism. Same story with the abnormal analytes of the first trimester screening.

    So, the bottom line is that somebody who had an abnormal screening test but the disease never develop should not become a paladin against the implications of an abnormal test. All abnormal screening tests require additional ascertainment. Such additional evaluation could require additional consultation with a sub-specialist.

    Disclaimer: Any typos are the responsibility of the auto-spell check.

    ;-)

    Reply
    • This is the most helpful comment I have come across and beats the real life explanations I have been given. Thank you!

      Reply
  78. I also wanted to share that I had low PAPP-A with my pregnancy (my first) 0.22 mom, we did a NIPT (as also had slightly high B-HCG) which showed no chromosomal abnormalities. Had additional scan at 23 weeks which showed “possible notching” on the blood flow of one of my uterine arteries and was recommended to have another 4 scans & possible induction at 37 weeks. After a lot of research and consideration, we declined most of the additional scans, (mainly due to the stress & worry they were causing & given everything else was fine) opting only for one at 36 weeks to check growth & size which was fine, as well as blood flow to the placenta (again fine). my BP was excellent throughout so at 36 weeks we requested and were discharged back to community midwife team & ended up having an awesome home birth at 43 weeks (yes – 3 weeks post EDD!). Our boy was a happy healthy 7lb4oz & is now 5 months and doing fab – Just got his first 2 teeth too!!

    Reply
    • Hi Tracy,

      I’m glad to hear that you had a good pregnancy and your boy is healthy! Good luck with the teething, our baby boy just started teething as well.

      Cheers

      Michael

      Reply
  79. I was diagnosed with low PAPP-A during my second pregnancy. It was like 0.1 mom. I worried the entire pregnancy. We did many ultrasounds. Everything else was normal with my son. I read so many horror stories about it. My result was normal blood pressure, giving birth after 41 weeks, and having a super healthy 9lb 5oz baby boy. I realize that not all low papp-a women have healthy outcomes, but I wanted to share my own experience to give hope to women who have low papp-a. My husband wonders about the accuracy of the test.

    Reply
  80. Fantastic conversation! My two cents are the following:

    1. The most widely accepted cut off for a PAPP-A to be considered low is 5.0 MOM. As with any other screening test in medicine, there will be false positive and negatives when trying to correlate a low PAPP-A with a poor pregnancy outcome.

    2. Any patient with a low PAPP-A and/or a low free BHCG (both are measured for the first trimester screening but not for the Harmony test) should consider requesting a consult with a Maternal-Fetal Medicine (aka perinatologist or high risk obstetrician) for additional evaluation and counseling. There are many really good general Ob/Gyn that promote their practices as also being capable of managing high risk pregnancies and they do so really well, but in this case you want to see a fellowship-trained sub specialist. You can search for one here: https://www.smfm.org/members/search?miles=&page=2&q%5Blast_name_start%5D=&q%5Bsearchable_addresses_city_cont%5D=&q%5Bsearchable_addresses_state_eq%5D=Georgia&utf8=✓&zip_code=

    3. Do not freak out. The great majority of patients with a low PAPP-A will do fine, however the additional consultation with an MFM doctor will help assessing objectively the level of concern.

    4. Do not seek an online consultation nor value online opinions above and beyond the real thing. Go and see a doctor. Yes, everybody can use the available online resources to learn more about a health problem but many times the information obtained will be biased and could lead to assuming the wrong posture. Michael did the right thing by quoting a meta-analysis. Although not without potential statistical problems, meta-analysis are thought to be the best way of assessing the published medical literature. Be aware that meta-analysis are not all-encompassing. The authors decide what papers are to be included in the analysis, which by itself could introduce selection bias.

    5. Do not stay quiet. If you have questions or if you do not understand the problem, say so and keep asking your doctors until you are satisfied with the answers.

    Reply
      • Michael:

        My pleasure! I always look forward reading your blog updates. BTW, the triplets are getting iPhones for their birthday presents. At school, the daughters are using Chromebooks (aka Crummy Books!). They absolutely hate them. Last weekend I took them to the Apple Store and the girls loved the 12″ MacBook in the rose-gold finish. I guess I should be happy I have an all Apple-loving household.

        Reply
  81. I just got diagnosed with low PAPP-A levels today so this is all very new to me, and I found your post very helpful. However, if I am reading this correct from above (“earlier studies have suggested that levels => 0.5 could lead to any of the following conditions:”), doesn’t this say that levels equal to or greater than 0.5? Isn’t it supposed to say less than (=<)? Or is this a fancier symbol for something I'm not familiar with?
    If it's a typo, I just wanted to point it out, if not I apologize and keep up the great writing!

    Reply
  82. Hi Thanks for all your helpful comments and information about low PAPP-A. I have been told I have low PAPP-A and my NIPT test has come back normal. I will be seeing consultant soon to discuss a management plam. Is there anything I can do to increase PAPP-A levels? like change my diet? I am prescribed asprin to take until the end of my pregnancy.

    Reply
      • That is not true . my doctor advise to take a low dose of aspirin until baby is born. Please discuss this with your doctor .

        Reply
        • Hi Diana,

          And I recommend following your doctor’s orders as it probably won’t hurt. But I haven’t seen any peer-reviewed studies that suggest Aspirin has a positive impact on your low PAPP-A.

          I wish you certainly all the best for you and your baby Diana! Remember, your low PAPP-A may not have any negative impact on your pregnancy.

          Michael

          Reply
          • Aspirin wont impact the low papp-a however it will aid in keeping.you bp inder control reducing your risk for pre clampsia

        • I was informed that there is nothing you can do to change the low Pappa (I was diagnosed at 12 weeks with it and now 33 weeks pregnant) I was prescribed low dose aspirin during this pregnancy but the aspirin is to help with the chance of pre-clamsia and not the levels of Pappa. There isn’t anything you can do with the Low Pappa except go for regular growth scans and if they find an issue then, then they can address it accordingly.

          And a side note I’m 33 weeks pregnant now and my little guy is growing perfectly so far. I start weekly scans after next weeks appointment as they believe at 34 weeks is when issues can start arising, but the doctors still keep telling me not to worry.

          Reply
        • Aspirin reduces the chances of preeclampsia. I know this because I’m Type 1 Diabetic and high risk for preeclampsia and that’s what I’ve been prescribed.

          Reply
  83. I had low Papp-a and was not offered additional growth scans. My baby died in utero at 36 weeks. I think the main point here is that low Papp-a can be indicative of potential issues later on, and these issues are entirely manageable, particularly by the third trimester, if they are in fact managed. Unfortunately mine were not. So I would encourage all mums with this low papp-a result to push for extra monitoring as sadly not every OB thinks it necessary.

    Reply
  84. I just wanted to update the ladies to say I had a Papp a of 0.08 I have previously wrote on here. On the 16 th march we were sent to kings hospital as problems were detected but not only did our baby girl at 21 weeks measure below 3rd percentile but they discovered she had tetralogy of fallot a major congenital heart defect but also that her vermis had not developed so she was diagnosed with dandy walker syndrome , sadly we ended the pregnancy at 22 weeks she was 195 g where most babies her gestation would be 400/450 g. I believe this Papp a testing does have relevance and although my bloods and amnio came back chromosomally normal my babies abnormalities were not detected until a lot later on in the pregnancy. If anyone else is going through this heartbreaking horrendous ordeal please feel free to speak to me on this site.

    Reply
    • Hi Joanne, I just read your post and I am so sorry for your loss. I also was told that I had a low Papp-A of .21. I was very worried but by OB seemed to think that there wasn’t much reason to worry because everything else looked fine. Unfortunately, in the 22nd week anatomy scan, my baby girl was also diagnosed with severe Dandy Walker Malformation and a small heart defect. We terminated at 23 weeks. She was just under a pound, so not far from expected weight. Like you, all genetic tests were normal. The Papp-A was the only number that was low. I see your post is over a year old and am wondering how are you doing? Wishing you the best.

      Reply
  85. I was told that I have a low PAPP-A at my 12 week fetal scan. They said it is a .25 and they want it to be a .5, I am so worried. Everything seemed to check out ok and the baby looked great. Measuring right on schedule. I just want to know what to prepare for and how likely it is for something to happen. I go back to be checked in July and then every 4 weeks after that. I know the chance of something happening is low but I just feel like I am in the dark about it.

    Reply
    • Hi Dena,

      How did everything turn out? I was recently diagnosed with a low PAP-A of .2 hoping for the best but still nervous

      Thanks in advance,
      Kira

      Reply
  86. Not to panic people but we lost our son last week at 25weeks gestation exactly the day before mothers day and we had a Papp a odlf .25 so it does happen.

    Reply
    • Hi Kelli,

      I’m very sorry for your loss but appreciate that you shared it with other (expecting) parents by leaving a comment.
      It’s not comparable to your loss, but we too started having issues at week 25, when doctors wanted to deliver our baby. He was ultimately born at 30 weeks and 6 days and surely my wife’s low PAPP-A levels must have gotten something to do with it (I figured), causing the placenta to not provide sufficient nutrients.

      However, the pathology report didn’t indicate any issues with the placenta at all, giving more credibility to the fact that individual cases (like yours and to a degree ours), don’t prove a relationship between low PAPP-A and bad outcomes. That’s were (meta)-studies come in handy, by looking at all studied cases combined.
      Ultimately, it is plausible that low PAPP-A could be an indicator of an underlying problem that could cause bad outcomes, but it doesn’t have to be. There are just as many cases of low PAPP-A that don’t lead to any issues.

      Again, I’m truly sorry for your loss and wish you all the best.
      Michael

      Reply
  87. Thank you so much for this. I was freaking out, but this was great reassurance that everything will be fine. Thank you again.

    Reply
  88. Just wanted to leave an update as I’m the lady with the low Papp a 0.08. At 19 weeks 4 days my baby was measuring below the 5th percentile, found out we are having a girl but she is showing signs of severe iugr. The consultant said I had done well getting this far in my pregnancy and hopefully the baby can hold on for another 6 weeks , trying to stay positive, but when I read my notes saying fetal demise and miscarriage and early onset iugr. It really isn’t looking good and mine is due to non existent Papp a .

    Reply
      • Hi Dana not realising what I had done, but I have left a message on Michael kummers website about low Papp a just to update you. Please feel free to message me if you need support . Kind regards Jo. My message has been left under the name of Joanne cuzen

        Reply
        • I just got my results also for a low level I think is 5*. I am dying because it is my first baby. I am 17 weeks. the doctor told me not to worried that it could be pre-clancia or something else associated with low grow of my baby. Everything alse is normal. please help

          Reply
  89. Just wanted to add a note of my findings for anyone who is reading this right after they received their results. PAPP-A is a zinc binding protein, and I have not found anyone or any study discussing the possibility of a zinc deficiency effecting either the function of PAPP-A or the blood test result. I am currently speaking to a doctor in Australia to carry out the study. I was breastfeeding my first child when pregnant with my second for 4 months until I received my low PAPP-A result with no other issues, no elevated AFP, no small placenta (if that is the case for you, you may be a real low PAPP-A candidate). I always thought it was the breastfeeding, it was, but my focus was incorrect, the breastfeeding was causing my zinc deficiency that I was unaware of, to get worse. I delivered my 7lb. 13oz daughter naturally at 41.5 weeks against doctors orders, and everything was fine (I even had GBS with no treatment, and she was still fine). If you only have low PAPP-A, buy a zinc tally taste test, or see a naturopath they should have some, it should taste extremely bitter if your zinc levels are normal, for me, it tasted like water, I also have beau’s lines in my nails which is further proof of zinc deficiency. I am now taking 25mg of zinc with a 10th of copper (too much zinc can make you copper deficient). Hope this helps!

    Reply
    • Hi Michelle,

      I’ve just been told I have low Papp A, only just in the low bracket though at 0.45.
      Im breastfeeding my 21mo and instead of taking my usual pregnancy multi vitamin I’ve been taking a higher dose of folic acid (I’m overweight and my mw recommend it). I’ve not been taking my bf multi vitamins for quite some time, so I’m wondering if this zinc deficiency could be a factor.

      Did you get anywhere with research in to this as I’d be really keen to see how it went/going.

      Many thanks!

      B

      Reply
    • I wanted to share my story as I found reading this thread of comments very helpful when I was given my result of low papp-a. At my first trimester screening I had a papp-a of 0.31 MoM, which also caused me to be screen positive for down syndrome. I subsequently had a non-invasive prenatal scan which ruled out downs and a bunch of other genetic abnormalities, but I was still worried about other potential adverse outcomes associated with my low papp-a. After seeing your post about zinc, I started doing some research on zinc deficiency. Although it’s relatively rare in the Western world, apparently it’s more common in vegetarians (I follow a vegetarian diet) because the best sources of zinc are in meat. I then checked the prenatal vitamin I was taking and realized the amount of zinc in it was actually very low, and much lower than the standard multivitamin I had been taking before we started trying to get pregnant. Around 15 weeks pregnant I started taking an additional zinc supplement daily (15mg Zinc + 2mg Copper, as Zinc supplementation can drain your body of copper). I’ll never know if it helped or not, but I’m happy to say that I delivered a healthy baby girl at 41+2 weeks (I had to be induced!), weighing 7 lbs 13 oz. She’s now 6 months old and in the 90th percentile for both height and weight. I hope my story can bring some comfort to people dealing with the stress of a low papp-a diagnosis because things can turn out just fine. It also might be worth trying Zinc supplementation (if your health care provider okay’s it). Good luck to everyone out there.

      Reply
    • This is super helpful thank you Michelle. I was breastfeeding until 7 weeks pregnant (this is my third child/pregnancy) and was told today at 13 weeks I have low PAPP-A (0.3). I am 36 years old. I’m in Australia with a great private OBGYN who has recommended I take 100mg of Asprin nightly to support good blood flow to the baby. They were incredibly reassuring and have told me not to worry. They said they’ll also be doing extra growth scans at 28 and 34 weeks to monitor growth. I’m waiting to get my naturopaths thoughts on the matter, she is an ex-midwife of 20 years and has recently studied Integrative Medicine so I’m sure she will have valuable input on the matter.

      Reply
    • I realize your post is old but I’d get this does that mean if Zinc causes the low PAPP A result there should be no concern? I learned I had Zinc deficiency right before I conceived. It would wonderful to know that is the only reason I got the low results

      Reply
  90. Also I don’t know if it’s worth mentioning but I came back a high risk for preeclampsia . And that’s also placental issues. I just hope it has the same happy ending that your family has been blessed with.

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  91. To be honest they have stated they really don’t know what the outcome will be for this pregnancy , I have never experienced this before in previous pregnancies. When ever they scan me they said everything is looking as it should , but I still have 6 weeks until my 20 week scan a lot can deteriorate in that time and I’m so scared my baby will just demise which is so sad as its a perfectly healthy baby.but yes they have basically come to this conclusion based on my Papp a level alone. I’ve been told to get on with my life prepare for the worst because if is going to happen it will happen. Are you referring to the link about not worrying about low Papp a levels?

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  92. My Papp a is 0.08. We have a chromosome normal baby, we’ve been told to prepare for late miscarriage, and fetal death in utero. I am 13 weeks 5 days and worried sick .

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    • Hi Joanne,

      I’m sorry to hear that and I can imagine how that feels. We felt the same way, but over here doctors confirmed that low PAPP-A with a chromosomal normal baby may not have any negative impact on pregnancy and studies back that up. However there may be other issues such as a problem with your placenta that you likely won’t see on an ultrasound yet. That was the case with our baby boy who was ultimately delivered healthy at almost 31 weeks.

      I’m surprised that doctors would make such a diagnosis based on just low PAPP-A – but they may see other risk factors. Did you ask them to comment on the study I posted a link to? Mine knew about it…

      Good luck!
      Michael

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  93. My Papp-a was extremly low. 0.01 percentil. I gave birth to a healthy girl week 39. She was 5.650 pounds. Little small but she gain way fast.

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      • Is baby and mum ok and why did your wife delivery early ?
        Congratulations !
        In 15 weeks and have been told I have low Papp a . Very worried and scared . Seeing the consultant a week on thurs to discuss it x

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        • Hi Jo!

          Both are fine and doing well fortunately. In our case, my wife’s placenta was aging prematurely and wasn’t providing sufficient nutrients. I wouldn’t worry about low PAPP-A too much – our doctors confirmed that it may not mean anything.

          Good luck!

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          • I’m researching low pappa as three days ago we gave birth to a sleeping baby boy – our scan Monday showed his heart had stopped – I was 30 weeks , we were told at 14 weeks my pappa levels were low that was it

          • Hi Chloe,

            I’m terribly sorry to hear that and wish you all the strength to process such a terrible loss!

            Have you been under close monitoring by perinatal specialists since they detected low PAPP-A levels at week 14?

            Michael

      • Hi Michael:
        My PAPP-A came back at 0.5 and I was told not to worry. My doctor said that anything =< 0.5 is considered low so 0.5 is still in the normal range (even though at the bottom of it). Were you told it’s low?
        Thanks!
        Céline

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    • Hello I hope you don’t mind me asking but with a Papp a that low how was your pregnancy managed?, mine is 0.08 I have been told my baby is going to die, the hospital have even offered me a termination to speed things up, which I’ve declined, I’m. Wondering are you just very lucky or do they really not know much about Papp a’s ?

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      • Hi Joanne,

        we had regular (weekly or bi-weekly) ultrasounds and at some point my wife got admitted to the hospital where they kept a closer eye on her and the baby. So for the last few weeks she was mostly on bed rest. Interestingly enough, the pathology report of her placenta didn’t show any issues such as premature aging, which is what doctors thought our issue would be. So nobody knows what caused our premature delivery but low PAPP-A wasn’t the cause.

        I think science doesn’t understand completely yet how low PAPP-A plays into thus. It’s apparently somehow related but it doesn’t appear to be the primary cause of pregnancy issues.

        Good luck!

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        • I’m currently 31 weeks pregnant and have to have an ultra sound every week until he is born. One week is to check his growth, then the next week is to make sure nutrients is flowing from the placenta to the baby. They say i have to deliver at 37 weeks. He currently only weighs 2lbs 6oz when really he should weigh around 3lbs 2oz. He’s very small and I’m very worried there could be more wrong with him. We did do the Down syndrome testing and that came back negative.

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    • OMG this is really a good news . I am currently 20 weeks and in my first trimester my PAAP A result was 0.06. So I have been booked in with more scans to monitor the growth. I am very worried because of the things I read online . This gave me a bit of reassurance.

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    • Hello, our son was low Papp A as well. We were part of a study. He carried full term plus a week. He was over 8 lbs. We had no issues with him at all. So in a opinion low Papp A is something that could indicate a problem.

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    • Hey Andrea, I was also tested and my Papp-a came back extremely low. Do you guys have any idea if my age have something to do with the low result? I’m 40 y/o and 19 weeks pregnant. I’m worried but trying to stay positive. I have a scheduled ultra sound 5 days from now. I hope to hear from you.

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