My experience with low Papp-A during my second pregnancy

How I’m navigating the high risk label

This blog isn’t intended to be taken as medical advice (I will keep reminding you of this throughout as I do share things that I am doing personally that may not be recommended to you by your midwife.) This is purely my experience of being told that I have low PAPP-A levels and how I’m managing this throughout my pregnancy. Please always consult your midwife or GP if you have any concerns and please do your own research.

Finding out that I had low PAPP-A levels during my second pregnancy

Shortly after our 12-week scan, about 2 days to be precise, I received a phone call from the midwife, well it was actually a voice mail as I missed the call. My heart was racing, I started shaking, all I could think about was the screening for birth defects. This was the only thing that I thought the call could be about so of course I started to panic, not another high risk pregnancy. I called back but each time the phone rang out and no one answered, to say that I was panicking was an understatement.

Eventually, after what felt like forever, I got through to the midwife, and she instantly reassured me that the genetic abnormalities tests had all come back low risk which was a relief but I couldn’t work out what the issue could be. I hadn’t agreed to any other screenings apart from this. She explained on the phone that the screening for PAPP-A had come back outside of the normal range. Now, I knew what this meant as a few of my hypnobirthing clients have experienced it but I asked her to explain it any way so that I could be sure.

‘The placenta isn’t functioning well’

This is what I was told, that my placenta wasn’t functioning as it should do, that there was a limited blood supply from the placenta to the baby and that meant that I was now classed as having a high-risk pregnancy. This meant that I would have extra growth scans and be consultant-led. Things such as stillbirth, low birth weight, pre eclampsia and induction were all mentioned straight away, it’s enough to make anyone panic.

Luckily, I had my hypnobirthing head on, so I wrote all of this down so that I didn’t come away from the phone call and forget everything. I asked her what my result was in terms of figures, this was important for me to know. I was told that the minimum ‘acceptable’ level to pass the screening was 0.415, my screening result came back at 0.39. I am so pleased that I asked this question as instantly I felt a bit of relief at the fact that this wasn’t too far away from the ‘acceptable’ level. I’m not a medical expert but even I could tell that the numbers were close in range.

Now, I’m not going to lie…

Pre hypnobirthing Hannah would have been such a mess hearing the words ‘the placenta isn’t functioning as it should do.’ If you are reading this and you too have been told that you have low PAPP-A levels and you are feeling anxious about it, then I totally get this, honestly, I would have felt the same without having the knowledge that I have. It’s not nice to hear that the thing that is nourishing your baby might not be working as well as it could be. There are a few things that I want you to know about low PAPP-A but first, let’s take a look at what PAPP-A actually is.  

What do low levels of PAPP-A in pregnancy mean?

PAPP-A, short for Pregnancy-Associated Plasma Protein-A, is a protein produced by the placenta during pregnancy. It plays a role in helping the foetus to develop by assisting in the regulation of insulin-like growth factor (IGF). PAPP-A levels can be measured through a blood test conducted during the first trimester of pregnancy, usually at your dating scan which often takes place around 12 weeks of pregnancy, alongside other tests like nuchal translucency ultrasound.

Low PAPP-A refers to a situation where the levels of this protein in the maternal bloodstream are lower than expected for a particular stage of pregnancy.

Some studies have suggested that low PAPP-A may be linked to an increased risk of pregnancy complications, such as preeclampsia, gestational diabetes, and preterm birth, please note that this isn’t a definite, this is purely a potential link, the key word here being potential. Other studies have also indicated that there may be an increased risk of intrauterine growth restriction, a small for gestational age baby and other risk factors for the baby. However, it's important to note that having low PAPP-A does not guarantee that such complications will occur, this is not a diagnosis, it is a screening test.

Therefore, additional growth scans, monitoring, taking low-dose aspirin on a daily basis to thin the blood and consultant-led care are often suggested. An induction of labour is also likely to be offered or be mentioned to you.

My thoughts as a hypnobirthing teacher about PAPP - A

I’ve been teaching hypnobirthing now for the past 5 years and it’s only within the past 2 years of teaching hypnobirthing that I have heard of more and more women being told that they have low PAPP-A levels, I have to ask myself why the sudden increase? Why hadn’t I heard about it as often in the 3 years prior when I was teaching hypnobirthing? I did a bit of digging. Here’s what I found…

Screening for low PAPP-A levels only started around 2016 and it wasn’t rolled out to all hospitals, in fact, some hospitals didn’t start screening for a while after this. This made sense to me as I was asked if I had low PAPP-A during my previous pregnancy back in 2017, I didn’t have low PAPP-A but perhaps I wasn’t even screened for it. So, it may be a possibility that I’ve heard of more and more women with low PAPP-A levels purely because they are now screening more people (the same seems to behappening with group B Strep too). This is only an observation that I am making purely on my own experience of pregnancy and being a hypnobirthing teacher. I cannot medically confirm if this is true or not but it does seem to make sense.

Since I’ve shared on my Instagram page that I’m experiencing a high-risk pregnancy, I’ve received lots of DM’s from people who are experiencing the same. It could be that more people are reaching out which is also why I’ve noticed an increase. I cannot be sure what the reason is behind this but it seems that there has been an increase in people receiving the information that they have low PAPP A levels too.

Things that I am doing during this pregnancy in regards to having low PAPP-A levels

Again, this is purely me documenting my own thoughts and experience, please do your own research and consult your midwife or GP.

I remind myself of these 4 things…

1/ The results of low Papp-A come as a result of a screening test result and not a diagnosis, they are very different things. A screening test means that there is a higher chance of a health problem, it does not indicate an actual health problem, only a diagnostic test can confirm a health problem. I remind myself that screening tests are not 100% accurate and do not always mean that things such as pre eclampsia, gestation diabetes or a small for gestational age baby will actually happen.

2/ Something that I have thought about recently is the fact that eating healthy and making sure that I’m looking after myself can only be a positive for the placenta and the baby, as with any pregnancy but more importantly during a high-risk one.

It baffles me as to why no one has mentioned this to me, not one person has suggested a healthy lifestyle / eating healthy to me. Surely, it makes sense that if there is the potential that the placenta may not be functioning as well as it should, in order to ‘help’ it, eating good food and living a healthy lifestyle would be recommended. During my own research, I have come across something called the Brewers diet which I am trying my best to follow, please do your own research on this.

3/ Induction has already been mentioned to me and I have a few thoughts about it. Firstly, I just want anyone who is reading this to know that Induction is an offer, you do not have to accept it and I would always advise doing more research into this before making a decision. I am not anti-induction but I do believe that it is overused and is not always necessary.

Knowing what I know about induction, I am aware that the artificial hormones can be really intense for babies but in particular, babies that are small for gestational age (SGA) or have intrauterine growth restriction. It just doesn’t make sense to me that if (and it is a big if as it might not happen) my baby is SGA or does have growth restrictions an induction would be the right thing for me or my baby. As things stand at the moment (I’m writing this at 33 weeks of pregnancy) I am happy to wait for spontaneous labour, my thoughts may change closer to the time.

4/ It’s also occurred to me that induction is likely to be offered as the risk of having a SGA baby and the risk of developing pre-eclampsia are potentially higher in those who have low PAPP-A levels. When speaking with my consultant, I am going to ask that induction is only offered to me if I actually do go on to develop pre eclampsia in late pregnancy or any other complications. If I don’t develop any complications then I do not want induction to be offered as a blanket policy. Lots of women with low PAPP-A levels won’t go on to have pre eclampsia and lots of babies won’t go on to be SGA. If at any point either of these things occur in my pregnancy then I will look at my options in terms of induction or a caesarean birth.

What actually happened…

Although I wrote this blog at 33 weeks pregnant, I didn’t actually publish it until now and my baby is 8 weeks old. You can find out what happened during my labour by reading my full birth story here.

If you have low Papp-A levels too…

I hope that if you too have been told that you have low PAPP-A levels during your pregnancy that this blog has perhaps helped you in some way or maybe even helped you to understand what options are available to you. Please do feel free to reach out at any point and if you are suffering with anxiety then I talk openly about this in a previous blog post here.

Please always make sure to speak with your GP or midwife if you have any concerns regarding yours or your baby’s health and please know that this blog post is not intended to be taken as medical advice.

Hannah xx

To continue reading my tips for labour, head to the Bump, Birth and Baby blog below: