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Thread: Low PAPP A Protein Level

  1. #1
    Join Date
    Jul 2011

    Default Low PAPP A Protein Level

    Hello. I was hoping to get your opinion on my latest issue with this pregnancy... a low PAPP A level. I am in the 2nd percentile. I am currently 19 weeks.

    Let me give you a little history first...We have 2 healthy children. I miscarried once in between having my first 2. The chromosomes were not normal w/ that miscarriage. When trying for our 3rd, I had 2 back-to-back miscarriages. The first one was at 6 weeks and we did not test the fetus. The 2nd was at 9 weeks and I had a sub-chorionic bleed, which got very bad. The chromosomes w/ that fetus were normal (assuming XX was the fetus and not me).

    This pregnancy started with a sub-chorionic bleed that cleared itself after a few days. The gestational sac measured about 2 weeks small the entire first trimester. I had a second bleed which never resulted in actual bleeding. It was present in uterus from approximately week 7-14. (but never changed size) It disappeared somewhere between weeks 14-17.

    I had an amnio which came back with totally normal results with no issues.

    I have Factor V Leiden and I take a baby aspirin everyday as a precaution. I have 2 sisters who have had numerous miscarriages that are unexplained (they also have Factor V and one has a mis-shaped uterus.) One of them had a loss at 37 weeks and ultimately after many miscarriages had her first via surrogate. The other has 2 healthy children and while trying for her 3Rd has had 5 back-to-back miscarriages--one at 17 weeks--the others early. (I give you this information b/c I am convinced something genetic is happening in our family!)

    So back to the latest...the low PAPP-A level. My doctor has explained that this could be associated with small babies, problems w/ the baby's growth, fetal demise, and various other things. He wants me monitored 2x a week with NST's and bio-physical u/s starting at 32 weeks. (He is very conservative.)

    So I would love your opinion on the situation/pregnancy. Is there hope that this pregnancy could turn out fine? How big of a problem or risk is the low protein level? Would your protocal of being monitored 2x a week be the same?

    Another opinion would be welcome!

    Thanks (in advance) so much.

  2. #2
    Join Date
    Sep 2008


    Dear Ifw1211,
    First off, let me express how sorry I am that you have experienced such difficulty in completing your family. That said, it does sound as if your doctor has initiated a very reassuring plan. It is important that we don't over interpret nor ignore many of the tests which are now available. Papp-a is an example. This "Pregnancy-Associated Plasma Protein A" is a growth factor associated with how your body responds to insulin. Although it has been associated with various conditions--as your doctor noted--it is by no means a sign of impending doom. I believe that the suggestion by your doctor of close surveillance is reassuring and reasonable. More importantly, if all other signs in your pregnancy remain reassuring at 19+ weeks then you should maintain a level of optimism. Please keep me informed and let me know if I can help clarify any further.

    Best thoughts,

    Robert Greene, MD, FACOG
    California IVF Fertility Center

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