Low PAPP-A Results after Nuchal Translucency Scan

[kaib]

Hi all,

I've just been reading this thread and wish how I had have come across all this information when I was pregnant with my little girl two years ago. I had a very similar experience to many of you, but only learnt about the real effects of low PAPP-A until it was thrown upon us. We were told at our 12/13 wk nuchal that I had very low PAPP-A, and we were given an overview of the potential complications of having low PAPP-A by the sonographer and specialist. My OB downplayed the low PAPP-A reading when we brought it up with him after the 12/13 wk scan, saying there was only an association and not a causal link between low PAPP-A and growth restriction etc etc. At our 12/13 wk scan, our little girl was measuring exactly to dates, so no alarm bells were ringing at the time. My sister also had similar low PAPP-A in both her pregnancies, and she carried both her girls to past full-term and very healthy weights. At our 19/20 wk scan, we found our little girl had started to slow in growth, but only by a week. It was then again the sonographer/specialist pointed out in their report of the links and risks with low PAPP-A, and its association with growth restriction etc. The sonographer/specialist recommended in their report that I have a growth scan done at 28-30 wks. I had to ask my OB whether he thought it necessary to go for this scan, and again he 'seemed to' downplay the seriousness of it all, recommending we go ahead with a later growth scan to provide us with reassurance. At 28&1/2 wks, I had my first growth scan and it was identified our little girl's growth had slowed down significantly, with her head and limbs ranging from 1-3 weeks behind and her abdominal circumference 3+ wks behind - she was under the 3rd percentile. My amniotic fluid was low and the blood flow through the cord was restricted. I was having regular uterine tightenings around that time too. I was told to give up work overnight, as it was likely I would be delivering our little girl before 32 weeks. I gave up work, was placed on home bed rest, was told to drink gallons of water, and to wait until a further growth scan a week later. The following growth scan showed an improvement in the cord flow, amniotic fluid, and improvement in bub's growth, so I continued in that fashion (having fortnightly growth scans and dopplers) until I reached 37 wks. At 37&1/2 wks our little girl's growth slowed down again, so they decided to arrange for a caeser. I was caesered at 38+4wks, with our little girl being born at 45cm and 2520g. She was placed in special care due to difficulty breathing and having low blood glucose. She was supplementally fed until my milk came in (because of her low blood glucose) and I took her home 4 days after her birth. She is now 17 months old, and weighs 8.84kg (still on 3rd percentile). She has had times of great catch-up growth along the way (getting past the 10th percentile), but then has plateaued again down on the 3rd percentile. She had terrible reflux (which we have only just weaned her off her reflux meds), and has been unable to tolerate cow's milk/dairy after numerous attempts of trying to introduce it into her diet. But other than her being a petite little thing, she is an energizer bunny - full of life, happy and reaching all other milestones. My OB was/is still unconvinced that our little girl had "growth restriction" secondary to low PAPP-A, or whether she was just always going to be a "small baby". However, he has acknowledged that we are at risk of having another growth restricted baby.

We are 12 wks pregnant and a week away from having our nuchal scan. I know a lot more about low PAPP-A now and feel 'ok' about going into the scan even with the history we've got. I am on low dose Aspirin due to my history of early miscarriage (3), and to help improve the blood flow to the placenta. I was interested to read in a recent post about the newest research on PAPP-A and the role of clexane, and will raise this with my OB if my PAPP-A is low this time around. I really hope that for you who are going through the experience of having low PAPP-A for the first time, that you seek out as much information as you can about it. Sometimes having too much information is not a good thing, but the opposite is also true. We were 'aware' of the links but kept on being reassured by well-meaning people "to stop worrying because it will all be ok"; however I don't think burying your head in the sand is the answer either. It did turn out ok for us in the end, but if I didn't have the ability to 'drop everything' by giving up work literally overnight, I don't think the outcome would have been the same.

Again, I have gained a lot from reading through your posts and thank you for being willing to share your experiences with others. I found it difficult finding information on the web on low PAPP-A when I was going through it two years ago, so your thread will be filling a need in this area. I will let you all know how my nuchal goes next week. I would be interested to hear if anybody has experienced more than one pregnancy with low PAPP-A.

Kaib