Low PAPP-A - any experiences?

[IVFat40]

Hello everyone, today I received a blood test result back that my PAPP-A is only 0.28 - I believe they ideally like it to be around 1 and anything below 0.4 is flagged as a concern. Just wondering if anyone else has experienced this, what your outcomes have been and any advice. Also if anyone knows where you can get the blood test re-done privately that would be brilliant. Thank you.

I should also say, I've had the NIPT blood test done too and thankfully baby came back very low risk for downs/edwards/patau's so I'm not too worried about the risk of those, but more worried that apparently low PAPP-A increases the risk of late miscarriage, pre-term birth, low birth weight and pre-eclampsia. I'm currently 13 weeks and 42, this was an IVF FET pregnancy, and I took steroids and progesterone for the first 12 weeks of the pregnancy (not sure if any of those could have impacted the PAPP-A).

[Pnw2020]

Hi

I found this leaflet online

hey.nhs.uk/patient-leaflet/...

Sounds like they will put you on low dose aspirin if not already taking this.

Hope that helps x

[IVFat40 in reply to Pnw2020]

Thank you so much hun. Yes had actually already recently started the aspirin just due to my age.

[Eternalwarrior]

Hello lovely,I am in a similar situation to you. I had IVF (also took steroids and progesterone, in addition to heparin, hydroxychloroquine and aspirin from week 16) and currently 29 weeks pregnant after a very long journey and multiple miscarriages, including a late loss. When I had my blood tests to screen for any chromosome abnormalities in my 12 week scan, my PAPP-A levels were very low and my free beta hCG very high so I was told there was a high risk the baby could have Down Syndrome. This came as I surprised as it was an IVF pregnancy and we had done PGT screening and tranferred an euploid embryo. I had the NIPT blood test and that came back normal, but one of the consultants we saw still recommended we had an amniocentesis, which we refused to do.

I have a high risk pregnancy and I am under consultant care. On my 16 week scan they realised I had problems with my uterine arteries that weren't dilating well and baby is very small and not growing very well, hence all the growth scans I am having... I asked the consultant if that could be related to my low PAPP-A levels and he told me it could be but that wasn't necessarily the case, as many women with low PAPP-A levels continue to have a problem free pregnancy. He mentioned that older mums (I am nearly 38!) and IVF pregnancies often cause lower levels of PAPP-A.

I was prescribed 150 mg aspirin after my 16 week scan, but was told I should have probably taken the aspirin since the beginning and definitely since my 12 week scan.

Sorry for the long post and I am not sure if this helps, but I wish you a lovely (and trouble free!) rest of your pregnancy xx

[IVFat40 in reply to Eternalwarrior]

Thank you so much, I really appreciate your message! The more information and experience the better as far as I'm concerned. And congratulations it's lovely to hear you're at 29 weeks, although it sounds like you've had a lot to overcome to get here. I'm so sorry for the worries you've been through during the pregnancy, it sounds like your little one is a very determined and strong small person.

It does seem very confusing with the PAPP-A, and that the medical profession themselves aren't that sure what it really means. I'm on the aspirin too and I think I'm going to ask for an extra growth scan before my 20 week one, it just feels too long to wait 12-20 worrying if something could be wrong. Wishing us both all the best.

[Eternalwarrior in reply to IVFat40]

Thank you, lovely! I think it is great you are on aspirin too and, if I were you, I would do the same and ask for an extra scan, maybe around week 16. All the very best and please let me know if I can help with anything x

[IVFat40 in reply to Eternalwarrior]

thank you 😊

[Chiefy]

Papp-a seems to be a bit of a strange one. Each hospital has a different definition as to what they consider low, mine was 0.3 something but wasn't considered low. I believe that in some places it isn't considered a severe enough risk factor to check. I was on low dose aspirin due to age, first pregnancy and ivf pregnancy anyway and had no issues. Just another thing to worry us about! X

[IVFat40 in reply to Chiefy]

Thank you hun, it's really good to hear that you were absolutely fine with it. It does seem a bit of an odd one, with the medical profession themselves seemingly still working out how worried or not we need to be about it.