Low Pregnancy Associated Plasma Protein-A (PAPP-A)

Patient Information Leaflet

You should have already received the results of the combined antenatal screening blood test by letter or phone call from the screening team. The combined antenatal screening blood test, performed between 11 and 14 weeks of your pregnancy, calculates your chance of carrying a baby with Edwards’ syndrome, Patau’s syndrome and Down’s syndrome. It also tests levels of a protein produced by the placenta called Pregnancy Associated Plasma Protein-A (PAPP-A).  You have been found to have low PAPP-A.

What does low PAPP-A mean?

Studies have shown that low levels of PAPP-A may be associated with the placenta not working as well as it should do. This might lead to low birth weight or fetal growth restriction (smaller babies), preterm birth (birth before 37 weeks gestation) or raised blood pressure and protein in urine, known as pre-eclampsia.

This risk of complications is small and it is important to remember that most babies born to mothers with low PAPP-A will be a normal weight at birth and the pregnancy will progress without problems.

For those babies that are found to be small, you will have the reassurance of regular scans and appointments in the consultant antenatal clinic throughout your pregnancy.

What happens now?

• In line with national guidelines, we recommend that you take low dose aspirin on a daily basis if you are not already doing so as this will promote the blood flow through the placenta to allow your baby to grow to it’s full potential. The recommended dosage is 150mg to be taken every evening throughout your pregnancy. This can be bought over the counter from any local pharmacy. Alternatively, you can take this information to your GP and ask them to prescribe it for you.
• National guidelines suggest that extra scans should be considered to check the growth of babies when a low

PAPP-A level has been found. You will be referred to a consultant antenatal clinic where a plan will be made to monitor your baby’s growth with regular scans

• At each scan, measurements will be taken of your baby’s head, abdomen (tummy) and femur (thigh bone) and used to calculate your baby’s estimated weight. This weight will be plotted on your growth chart which will monitor your baby’s progress.
• Most babies will grow normally, however, if the growth of your baby is less than we expect, we will monitor your pregnancy more closely and there may be a possibility of an early delivery.

Is there anything else I can do to help my baby grow well?

If you smoke, it is extremely important that you stop. Smoking can seriously affect the function of the placenta and the baby’s growth. We have a dedicated Healthy Pregnancy Support Service (HPSS) that can help you to stop smoking by providing support and nicotine replacement therapies. Your community midwife can refer you or you can refer yourself by one of the following options:

• Call 01384 244358
• Email hpss@nhs.net
• ‘The Dudley Healthy Pregnancy Support Service’ page on Facebook

 Who can I speak to if I need further information?

If you have any queries or concerns, you can contact your community midwife. Alternatively, you can call any of the contacts below:

• Antenatal screening team: 01384 456111 (ext. 3116)
• Antenatal clinic midwives: 01384 456111 (ext. 3351)

If you have any questions, or if there is anything you do not understand, please contact the Russells Hall Hospital switchboard number on (01384) 456111 and ask for the relevant department who issued this leaflet.

This leaflet can be made available in large print, audio version and in other languages, please call 0800 073 0510.

Author: Mel Bullas
Document No: DGH/PIL/02139 –  Version No: 02
Date originated: December 2025 – Review date: December 2028