Management of Women with Low Pregnancy Associated Plasma Protein (PAPP-A)

Patient Experience

  • Reference Number: HEY1021/2024
  • Departments: Maternity Services
  • Last Updated: 31 January 2024


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 doctor to inform them of this result and he can issue you with a prescription for aspirin, which is the recommended treatment and should be taken in a low dose every day until the baby is delivered.

At every appointment with either your midwife or doctor, you will be offered to have your blood pressure measured and your urine checked for protein. You will also be offered regular ultrasound scans in order to monitor your baby’s wellbeing by taking measurements of your baby’s growth, 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 your 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?

Your antenatal care will be with your midwife, and you will be offered an appointment with a consultant obstetrician in the antenatal clinic to discuss further management and planning. If you have had an anatomy scan at 20 weeks then a customised growth chart will have been added to your hand held records so the growth of your baby throughout pregnancy can be monitored. You will continue to see your community midwife for your routine appointments but they will not measure your abdomen if you are 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 until the birth of your baby.  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 by a midwife and doctor.

Due to the associated risks of low PAPP-A, it is recommended that labour is induced around your due date. However, you will have a full discussion of the process of induction of labour including risks and benefits before any decision is made.

You will also be able to have a discussion with the doctor and midwife about monitoring your baby in labour, as it is recommended that women who have low PAPP-A have continuous heart rate monitoring of their baby in labour. This method of monitoring isn’t available on the Fatima Allam Birth Unit or at home, and is only available on Labour Ward. We do have facilities to enable you to labour and birth in water using telemetry monitoring (a wireless, waterproof system) and this can be discussed with the doctor or midwife.

What can I do to help?

If you smoke, it is important that you stop 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 programme or you can refer yourself by calling the helpline for support on 01482247111 (if you live in Hull) or 08009177752 (if you live in the East Riding) or 01724298 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: 01482382623 or the Antenatal Day Unit: 01482382729.

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