Low PAPP-A in Pregnancy - Patient Guide

What is PAPP-A?

PAPP-A stands for Pregnancy-Associated Plasma Protein-A.

In simple terms: PAPP-A is a protein made by the placenta during early pregnancy. It helps the placenta grow and attach to the uterus.

We measure PAPP-A levels in your blood during the first trimester (around 11-13 weeks). This is part of routine pregnancy screening.

PAPP-A levels tell us how the placenta is developing in early pregnancy.

What Does a Low PAPP-A Mean?

A low PAPP-A means your level is below the 5th percentile for your stage of pregnancy.

This is a marker, not a diagnosis. It tells us the placenta might need extra attention, but it doesn't mean something is definitely wrong.

What it can indicate:

The placenta may not be attaching as deeply as expected
Slightly higher chance of genetic conditions (if not already tested)
Possible risk for growth or blood pressure issues later

Important: Many pregnancies with low PAPP-A progress normally with careful monitoring.

Is Something Wrong With My Baby?

Not necessarily. A low PAPP-A means we'll watch your pregnancy more carefully.

If your genetic screening (NIPT/cfDNA) was normal:
We're not worried about chromosomal conditions. Our focus is on placental function and growth.

If you haven't had genetic testing yet:

We may recommend cell-free DNA testing or diagnostic testing
This helps us rule out chromosomal causes
Once genetics are confirmed normal, we focus entirely on monitoring

Low PAPP-A is about risk assessment, not a current problem with your baby.

How We'll Monitor Your Pregnancy

Our monitoring plan includes:

18-22 weeks

Detailed anatomy scan

28 weeks

Growth ultrasound #1

32 weeks

Growth ultrasound #2

36 weeks

Growth ultrasound #3

What we're checking:

Baby's estimated weight and growth pattern
Amniotic fluid levels
Blood flow through the umbilical cord (if needed)

If growth stays normal, we continue routine prenatal care.

What Can You Do?

1. Attend all monitoring appointments
These ultrasounds are how we catch any changes early.

2. Consider low-dose aspirin
If you have other risk factors (like being over 35 or having high blood pressure), we may recommend baby aspirin (81mg daily) before 16 weeks to support placental health.

3. Report any concerns promptly
Let us know if you notice decreased movement, bleeding, or severe headaches.

4. Continue healthy pregnancy habits
Good nutrition, staying hydrated, avoiding smoking, and managing any medical conditions all support your baby's growth.

Will I Need Early Delivery?

Most patients do not need early delivery.

If your baby continues to grow well on ultrasounds, we'll plan for a normal delivery around your due date.

We consider earlier delivery only if:

Baby's growth slows significantly (growth restriction)
Blood flow patterns become abnormal
You develop preeclampsia (high blood pressure with protein in urine)
Other complications arise that make delivery safer than continuing pregnancy

Our goal: Balance giving your baby time to grow with delivering before any problems become serious. We'll discuss timing together if needed.

What About Future Pregnancies?

Low PAPP-A in one pregnancy does not necessarily repeat in future pregnancies.

For future pregnancies:

Let your provider know you had low PAPP-A before
You may have closer monitoring from the start
Early aspirin therapy may be recommended
First-trimester screening will be important again

Each pregnancy is different. Having low PAPP-A once doesn't mean you'll have complications in future pregnancies.

Should You Worry?

Worry is natural, but not necessary.

Low PAPP-A is one piece of information that helps us provide better care. It doesn't mean your pregnancy will have problems—it means we're paying attention.

Many pregnancies with low PAPP-A

Progress normally

Early monitoring helps us

Catch issues early

You're not in this alone. Our team will monitor your pregnancy closely and make decisions together with you every step of the way.

Video Guide: Understanding Low PAPP-A

For a detailed video explanation of low PAPP-A in pregnancy, watch our comprehensive guide.

This video covers:

What PAPP-A means and why it's measured
Potential risks and monitoring strategies
What you can do to support your pregnancy
Answers to common patient questions

🎬 Watch the Video:

View Video Guide →

Key Takeaways

1. Low PAPP-A is a marker, not a diagnosis
It tells us to watch your pregnancy more carefully.

2. If genetics are normal, we focus on growth
Extra ultrasounds help us monitor how your baby develops.

3. Most pregnancies progress well
Close monitoring is about prevention and early detection.

4. We're partners in your care
You'll be involved in every decision about your pregnancy.

Questions? Please don't hesitate to reach out to our team anytime. We're here to support you throughout your pregnancy journey.