Low PAPP-A during pregnancy - what it means and do you need to be concerned?

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.

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!

  • Andrea says:

    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.