Low Pregnancy Associated Plasma Protein-A (PAPP-A)
Information for women, birthing people, and their families
This leaflet is for women or birthing people who have been found to have low PAPP-A. Low PAPP-A is officially known as low Pregnancy Associated Plasma Protein-A.
What is PAPP-A?
PAPP-A is a protein that is a hormone made by the placenta (the afterbirth). It is measured as part of the combined screening blood test.
Low PAPP-A is defined as less than 0.415 MoM (multiple of the median).
What does low PAPP-A mean?
Low PAPP-A levels are found in about 5 of every 100 pregnancies. Most babies with low PAPP-A are born on time, with a normal birthweight. It usually does not affect your pregnancy or birth plan.
Low levels of PAPP-A can be linked to an increased chance of pregnancy complications. These complications can include:
a smaller than expected baby (growth restricted); or
a baby born earlier than expected (preterm) baby.
There is also a slightly higher chance of developing pre-eclampsia. Pre-eclampsia is a condition that can develop during pregnancy, usually after 20 weeks. It affects blood pressure and kidney function. Pre-eclampsia needs careful monitoring to keep both you and your baby safe.
The risks of these complications developing are small. You will be offered additional monitoring to make sure that you and your baby are kept as safe as possible.
What does this mean for my pregnancy?
Now that your blood test results are back, you may be offered some additional tests. Which of the following tests you have, will depend on your personal situation and your scan results.
Uterine artery Dopplers measurement. This measurement gives us more information about the blood flow from you to your baby (in your womb). The measurement will be taken during your routine 20-week anomaly scan. This scan can also be called the mid-pregnancy scan; or detailed scan.
For more information, please read the Uterine artery Doppler ultrasound leaflet.
Growth scans. You will be offered a series of scans to monitor the growth of your baby. This includes measuring the amniotic fluid volume (water around baby).
These scans and measurements help us to support you and your baby during your pregnancy. Their frequency will depend on your and your baby’s individual circumstances. They give us important information about your and your baby's wellbeing
From 32 weeks if there are no concerns about your baby’s growth, your scans will be every 3 to 4 weeks. These will continue until the birth of your baby. If there are any concerns about your baby’s growth or wellbeing, you will be offered further scans. You will also be asked to attend Maternity Triage for a review.
Routine antenatal appointments. You will continue to have your blood pressure and urine checked by your midwife. This is so any changes can be found at an early stage.
Low dose aspirin. In line with national guidelines, we also recommend that you take a low dose of aspirin every day. Please take this every evening. The recommended dose of Aspirin is 150mg. You can continue taking aspirin throughout your pregnancy, until at least 36 weeks. Your doctor or midwife may suggest you continue taking it until the birth of your baby. You can discuss this with your midwife or doctor if you are unsure. Aspirin may help to reduce the risks associated with complications of low PAPP-A.
Aspirin is cheap to buy and can be bought from supermarkets and pharmacies. Alternatively, your GP may be able to prescribe it for you. Speak to your midwife if you are having difficulties with this.
Taking aspirin can help prevent the risk of pre-eclampsia and growth restriction for your baby. For more information, please read the Low dose aspirin (150mg) in pregnancy leaflet.
What can I do to help?
Monitoring your baby’s movements is very important during pregnancy. Most people usually begin to feel their baby move between 16 and 24 weeks of pregnancy. Feeling your baby move is a sign that they are well. It may be a sign that your baby is not well, if you notice that your baby’s movements have:
slowed down
increased significantly
changed; or
stopped.
Contact Maternity Triage immediately if you notice any changes to your baby’s movements. This could save your baby’s life. Their number is 01227 206737, they are available 24 hours a day, 7 days a week.
Smoking can affect your baby’s growth, by reducing how well the placenta works. If you smoke, your midwife can refer you to our specialist team for support during pregnancy. They can offer advice and help, including nicotine replacement therapy.
Contact details
Maternity Triage
Telephone: 01227 206737 for help and advice 24 hours a day