• Reference Number: HEY1021/2018
  • Departments: Maternity Services

You have been sent this leaflet because your recent blood test has shown that one of the hormones (PAPP-A) measured during your combined screening test is lower than expected. This does not affect the results of the screening test that you have already been given.


This leaflet has been produced to give you general information about low PAPP-A.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your midwife or doctor, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team who is caring for you.

What is PAPP-A?

Pregnancy associated plasma protein-A (PAPP-A) is a hormone that is made by the placenta (afterbirth) in pregnancy. It is measured as part of the combined screening blood test.

What does Low PAPP-A mean?

Low levels of PAPP-A (when it is less than 0.4 MoM in pregnancy) may be associated with:

  • A lower birth weight baby as your placenta may not work as well
  • An increased chance of having an early birth
  • Miscarriage in the second half of pregnancy
  • An increased chance of developing pre-eclampsia

With the aim of preventing these problems a letter has been sent to your GP to issue you with a prescription for aspirin which is taken in a low dose every day until you have delivered your baby. Also at every appointment with either your midwife or doctor, your blood pressure will be measured and your urine checked for protein.

You will also have regular ultrasound scans in order to monitor your baby’s wellbeing. Measurements will be taken of your baby’s growth and also of your baby’s placental blood flow and the amount of amniotic fluid around your baby. The appointments for your scans will be sent through the post. You should also remain aware of your baby’s movements and follow the advice your midwife will give you at the 16 week appointment.

Receiving the news that you have low PAPP-A levels may cause anxiety but please be assured that the majority of babies will have normal growth and the pregnancy will progress without problem.

What will happen now?

You will have consultant led care in your pregnancy and will be seen by a doctor in the antenatal clinic after your anatomy scan to discuss further management and planning. A customised growth chart will be added to your hand held records when you have your anatomy scan. You will continue to see your community midwife for your routine appointments but they will not measure your abdomen as you will be having regular scans to monitor your baby’s growth and wellbeing.

If there are no concerns about the baby’s growth, then the scans will be at 3 weekly intervals between 28 weeks and 40 weeks.  However if there are any concerns about the baby’s growth or well-being, you will be asked to attend the antenatal day unit (ADU) to be seen a midwife and doctor.

Due to the associated risks of low PAPP-A you will be offered an induction of labour around your due date. You will have a full discussion of the process of induction including risks and benefits with your doctor when your induction is arranged.

It is recommended that women who have low PAPP-A have continuous heart rate monitoring of their baby in labour. This means you will need to birth on the labour ward instead of the Fatima Allam Birth Unit. You may still be able to labour and birth in water if there are no other risk factors that would exclude you from safely considering water-birth. Monitoring of the baby can be done using telemetry monitoring (a wireless, waterproof system). You can discuss this option with your consultant.

What can I do to help?

If you smoke, it is important that you quit smoking as smoking can affect the function of your placenta and reduce your baby’s growth.

Your midwife can refer you to the smoking cessation program or you can refer yourself by calling the helpline for support on (01482) 247111 (if you live in Hull) or 0800 9177752 (if you live in the East Riding) or (01724) 298 212 (if you live in North Lincolnshire).

Who can I speak with if I need further information?

You can speak to your midwife at your 16 week appointment or your consultant after your anatomy scan if you have further questions.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Antenatal Clinic: (01482) 382623 or the Antenatal Day Unit: (01482) 382729