You have been given this leaflet because your recent blood test has shown that the level of a hormone (PAPP-A) measured at your combined screening test is lower than expected. This does not affect the results of the screening test that you will have already received

  • PAPP-A stands for Pregnancy Associated Plasma Protein-A. It is a hormone produced by the placenta. It is needed for the implantation process and to maintain a healthy placenta. 
What does low PAPP-A mean?

Low PAPP-A is not uncommon, even though you may not have heard of it before. Low levels of PAPP-A (Less than 0.415 MoM) are sometimes associated with:

  •  A smaller than expected baby 
  • An increased chance of having your baby earlier than expected
  • An increased chance of developing pre-eclampsia (raised blood pressure and protein in your urine during your pregnancy)
  • An increased risk of miscarriage in the second half of pregnancy

 It is important to note that most babies born to women who have low PAPP-A will have a normal birth weight and be born at the expected time. Please be assured that you will receive close surveillance and be referred for consultant-led care.

How is low PAPP-A managed?

If you are found to have low PAPP-A levels in your blood this will be discussed with you by your midwife and an antenatal clinic appointment will be offered. 

Aspirin is no longer recommended for an isolated low PAPP-A. 

Your midwife will measure your blood pressure and test your urine at each antenatal appointment, it is important that you attend each appointment scheduled for you. 

You will be offered extra ultrasound scans during your pregnancy to check your baby’s wellbeing. This will include measuring the blood flow to the uterus, growth, placental blood flow and the amount of amniotic fluid around your baby. Each scan will be followed by an appointment so that the scan can be reviewed and discussed with you. 

What can I do to help?

 As smoking can affect the placenta and the growth of the baby we recommend that all pregnant women stop smoking. We have a dedicated smoking cessation service which provides help and support, your midwife can arrange this for you. You can also find more information on www.nhs.uk/smokefree.

It is also important to monitor your baby’s movements throughout your pregnancy. If your baby’s movements slow down or stop you must contact your maternity unit immediately. 

What about delivery?

If no issues are identified during your pregnancy then there is no indication for early delivery. You will be offered a discussion with your consultant around the benefits and risks of having an induction of labour around your due date. 

If there are any medical concerns or your baby is smaller than expected, you may be offered an earlier induction of labour. However, you will have a full discussion on the process of induction of labour including risks and benefits before any decision is made.

Important information

This information leaflet is for guidance purposes only and is not provided to replace professional clinical advice from a qualified practitioner. Please speak to your midwife or consultant if you have any further questions. 

Confidentiality

‘The Trust’s vision is to keep your information safe in our hands.’ We promise to use your information fairly and legally, and in-line with local and national policies. You have a right to understand how your information is used and you can request a copy of the information we hold about you at any time.

For further information on confidentiality contact the Information Governance Team:

Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

pals@ncic.nhs.uk | 01228 814008 or 01946 523818

If you would like to raise a complaint regarding your care, please contact the Complaints Department:

complaints@ncic.nhs.uk | 01228 936302