Log In

Decoding Low PAPP-A Results in Pregnancy: What You Need to Know

Questions often arise about the significance of a low PAPP-A result during pregnancy. What does it mean, what causes it, and should there be concerns about the baby's well-being? In this exploration, we delve into the intricacies of PAPP-A, shedding light on its role, testing methods, and the complexities surrounding low results.

Understanding PAPP-A:  PAPP-A, or Pregnancy-Associated Plasma Protein-A, is a placenta-produced protein unique to each pregnancy[^1^]. It becomes detectable in the mother’s blood by the 12-week scan as the placenta forms and embeds itself into the uterine wall.

Testing Methodology:  PAPP-A is one of the proteins tested during a trisomy screen, usually performed at 12 weeks[^2^]. It’s not actively screened for but is an incidental finding, sometimes coming as a shock to parents. The combined test, which includes PAPP-A and bHCG levels, assesses potential chromosomal differences[^2^].

Defining a “Low” Result: Similar to varied natural attributes, what constitutes a normal PAPP-A level varies among individuals. Comparisons are made using the MoM value, with 1 being more average and likely normal for the specific pregnancy[^2^]. A level around 0.4MoM is often considered “low,” but it’s crucial to note that this doesn’t necessarily imply issues.

Interpreting Low PAPP-A: A low PAPP-A level itself may not carry significant meaning. It influences the combined test result, elevating the estimated risk of chromosomal conditions[^2^]. Importantly, low PAPP-A is associated with placental issues, such as growth restriction for the baby[^1^].

Implications and Recommendations: Parents with low PAPP-A may be offered aspirin to encourage blood flow and growth scans to monitor the baby’s well-being[^1^]. Even when all appears normal, they may be advised an induction around their due date as a precautionary measure.

Questions to Ask Your Healthcare Provider:
1. **How does my specific PAPP-A level impact the overall assessment of my pregnancy?
2. **What additional tests or screenings are recommended given my low PAPP-A levels?
3. **Are there lifestyle changes I should consider to support optimal placental function?
4. **What are the potential implications for my baby’s growth, and how will it be monitored?
5. **Should I be concerned about pre-eclampsia, and what preventive measures are advisable?
6. **How frequently should I undergo ultrasound scans to track my baby’s growth?
7. **Is daily aspirin recommended for me, and are there any potential side effects?
8. **What signs or symptoms should I be vigilant about, considering my low PAPP-A levels?


Navigating the complexities of low PAPP-A results requires an understanding of its nuances. Ongoing research aims to enhance our comprehension and provide more accurate guidance to expectant parents. If you find yourself in this situation, open discussions with healthcare professionals can offer personalized insights and help you make informed decisions throughout your pregnancy journey.


[^1^]: Smith, G. C., Stenhouse, E. J., Crossley, J. A., Aitken, D. A., Cameron, A. D., & Connor, J. M. (2002). Early Pregnancy Levels of Pregnancy-Associated Plasma Protein A and the Risk of Intrauterine Growth Restriction, Premature Birth, Preeclampsia, and Stillbirth. The Journal of Clinical Endocrinology & Metabolism, 87(4), 1762–1767.

[^2^]: Spencer, K., Cowans, N. J., & Molina, F. (2008). First trimester ultrasound and biochemical markers of aneuploidy and the prediction of preterm or early preterm delivery. Ultrasound in Obstetrics and Gynecology, 31(2), 147–152.