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Date issued: July 2025
For review: July 2027
Ref: A-682/JN/Early Pregnancy/Low PAPPA Advice
PDF: Low Pregnancy Associated Plasma Protein A (PAPPA) Advice final July 2025.pdf[pdf] 260KB
As part of our first trimester screening programme, we measure a hormone in your blood called PAPP-A. It stands for Pregnancy Associated Plasma Protein A and is a protein produced by the placenta. We have found this hormone to be at a lower level in your blood; this is found in 1 in 20 (5%) of pregnancies.
In most cases, PAPP-A does not have an impact on your pregnancy, but there is research to suggest that a lower level of PAPP-A (less than 0.415 MoM) may be associated with:
A lower birth weight baby due to the placenta not working as well as expected
An increased chance of developing pre-eclampsia
An early birth
To help try and prevent some of these problems developing, it is recommended that you take aspirin 150mg daily, with your evening meal as soon as possible after 12 weeks before 16 weeks until the end of pregnancy. Aspirin is inexpensive and can be purchased in all chemist shops and most supermarkets. To achieve the correct dose, you can take two 75mg tablets together or cut a 300mg tablet in half.
To monitor for growth and development, serial growth scans will be arranged during your pregnancy as per the national recommendations of Saving Babies Lives. The frequency of these growth scans will be arranged after your routine 20-week scan on completion of uterine artery dopplers.
Uterine artery doppler studies look at the pressure of the blood flow to the back of the placenta indicating how well the placenta could work. If these pressures are within expected ranges, serial growth scans will be arranged for 32, 36 and 39 weeks of your pregnancy. If these uterine artery dopplers are not within the expected ranges or we are unable to measure these for any reason, an additional growth scan will be arranged for 28 weeks alongside the 32, 36 and 39 weeks.
From 25 weeks you will see your community midwife who will check your blood pressure and urine sample for signs of protein (this may indicate pre-eclampsia developing). As you are having additional growth scans, the external measurement of your uterus height is not indicated as the scans provide a more accurate measure of baby.
You will have an appointment in a consultant antenatal clinic to discuss and devise an individualised care plan. If scans are normal and no intervention is required, you will be offered induction of labour 7 days after your due date.
It is well known that smoking can negatively affect baby’s growth and placental function, and we encourage all women to stop smoking in pregnancy. We have dedicated treating tobacco dependence practitioners available, and your community midwife can refer you if you would like help to stop smoking.
Maintaining a healthy weight and gentle exercise is encouraged in women who are found to have low PAPP-A, as it is in all pregnancies.
Receiving news that you have a low PAPP-A level can cause anxiety, but please be assured that in most cases no problems develop. Please speak with your community midwife if you have further questions.
The Royal College of Obstetricians and Gynaecologists (RCOG) has information available which can be found here:
Having a small baby patient information leaflet
