Test Detail
Interpreting Results

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Written by
Dr. Shreya Gupta
BDS, MDS - Oral and Maxillofacial Pathology
Reviewed by
Dr. Ashish Ranjan
MBBS, MD (Pharmacology)
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Pregnancy-Associated Plasma Protein-A

Pregnancy-Associated Plasma Protein-A
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This test is for
Test Preparation
  1. No special preparation required


What is PAPP-A?

Pregnancy associated plasma protein A (PAPP-A) is a protein which is formed by the placenta and its levels increase with the duration of pregnancy. Variety of tissues express PAPP-A at very lower levels. Plaques which are not stable in coronary arteries also express PAPP-A in high levels. This test measures the levels of Pregnancy Associated Plasma Protein A (PAPP-A) in blood. It is used for prenatal screening in the first trimester of pregnancy.

Why is PAPP-A done?

  • For prenatal screening in the first trimester of pregnancy

  • To detect Down syndrome

  • To detect Trisomy 18

What does PAPP-A Measure?

PAPP-A test measures the levels of Pregnancy Associated Plasma Protein A (PAPP-A) in blood. PAPP-A is a protein which binds to zinc that acts as an enzyme. It is used in prenatal screening in the first trimester of pregnancy and atherosclerosis. If PAPP-A levels are low in pregnant women at 8 - 14 weeks of pregnancy, there is a risk of restriction of intrauterine growth, premature delivery, trisomy 21, preeclampsia (pregnancy induced hypertension) and stillbirth.

This test assesses the risks of disorders like Down's Syndrome (trisomy 21) and Edward's syndrome (trisomy 18). In these syndromes, the levels of PAPP-A decrease and the space at the neck of the fetus is larger than normal.

Interpreting PAPP-A results


High Levels may indicate the following:

  • Pregnancy

  • Myocardial infarction

  • Unstable angina

Low Levels may indicate the following:

  • Trisomy 18

  • Down Syndrome

Answers to Patient Concerns & Frequently Asked Questions (FAQs) about PAPP-A

Frequently Asked Questions about Pregnancy-Associated Plasma Protein-A

Q. How is this test performed?
This test is performed on a blood sample. A syringe with a fine needle is used to withdraw blood from a blood vessel in your arm. The healthcare provider will tie an elastic band around your arm to make the blood vessels swell with blood. This makes it easier to withdraw blood. You may be asked to tightly clench your fist. Once the veins are clearly visible, the area is cleaned with an antiseptic solution and then the needle is inserted into the blood vessel to collect the sample. You will feel a tiny pinprick during the procedure. Blood sample once collected will then be sent to the laboratory.
Q. Is there any risk associated with this test?
There is no risk associated with the test. However, since this test involves a needle prick to withdraw the blood sample, in very rare cases, a patient may experience increased bleeding, hematoma formation (blood collection under the skin), bruising or infection at the site of needle prick.
Q. Is there any preparation required before the test?
Inform the doctor about the medications you may be taking. No other specific preparations are usually required before this test.
Q. What is Trisomy 18?
It is also known as Edwards Syndrome which is caused by development of extra chromosome 18 which disturbs the normal pattern of development in the baby even before its birth. The effects caused by Trisomy 18 are very complicated as compared to Down syndrome. The effects are so severe that it can cause stillbirth (death at the time of birth) of the child.
Q. Can PAPP-A test found positive in men also?
Yes, it can be found positive in men having acute coronary heart diseases like unstable angina, myocardial infarction or in men having ruptured or unstable plaques in the arteries.
Q. What is Down's syndrome?
It is a genetic disorder in which extra genetic material from chromosome 21 is transferred to the fetus. This transfer affects the development of the fetus leading to abnormal development both physically and mentally. The affected baby will have a small head and short neck, obliquely positioned eyes looking in an upward direction, large tongue coming out of the mouth, flat face, wide hands with short fingers, and lack of muscle tone.
Q. Are there any other tests required with PAPP-A test?
Before going for PAPP-A test, the doctor advises for the ultrasound. Other tests which may be advised are the b-hCG test or Double marker test.
Q. Is PAPP-A test only used for pregnancy?
No, apart from pregnancy, PAPP-A test is found positive in patients of Acute coronary heart disease such as unstable angina, myocardial infarction or in patients having ruptured or unstable plaques in the arteries.
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