PAPPA (Pregnancy Associated Plasma Protein -A)
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Marker of certain chromosomal abnormalities such as Down syndrome (Trisomy 21) and Trisomy 18
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🧪 What is PAPPA (Pregnancy-Associated Plasma Protein-A)?
PAPPA is a protein produced by the placenta during pregnancy. It is one of the two main components of the first-trimester prenatal screening, often paired with Free Beta-hCG, in the Double Marker Test.
Low levels of PAPPA can be a marker of certain chromosomal abnormalities such as Down syndrome (Trisomy 21) and Trisomy 18, especially when combined with other markers and maternal age.
❓ Why is the Test Done?
To:
- Screen for chromosomal abnormalities (Trisomy 21, 18, and 13)
- Detect early signs of pregnancy complications such as:
- Intrauterine growth restriction (IUGR)
- Pre-eclampsia
- Miscarriage
- Stillbirth
It is typically done between 11 to 13 weeks + 6 days of gestation as part of first-trimester screening.
📊 Normal Range (Multiples of Median – MoM)
PAPPA MoM Value | Interpretation |
|---|---|
>1.0 MoM | Considered normal |
<0.5 MoM | Suggests increased risk for Trisomy 21 or Trisomy 18 |
0.5 – 1.0 MoM | Borderline – requires interpretation with NT & β-hCG levels |
Note: Values vary based on gestational age, maternal weight, ethnicity, and lab methodology. Always interpreted as part of a risk algorithm.
🧠 Associated Conditions
System | Conditions Associated with Abnormal PAPPA |
|---|---|
Genetic | Trisomy 21 (Down syndrome), Trisomy 18, Trisomy 13 |
Placental | Pre-eclampsia, IUGR, placental insufficiency |
Fetal | Miscarriage, intrauterine demise |
🔄 Related / Follow-Up Tests
- Free β-hCG – forms the Double Marker Test with PAPPA
- Nuchal Translucency (NT) via ultrasound
- Non-Invasive Prenatal Testing (NIPT) – if high-risk detected
- Chorionic Villus Sampling (CVS) – invasive confirmation
- Quadruple Test (in 2nd trimester)
✅ Fasting Required?
Test | Fasting Required |
|---|---|
PAPPA | ❌ No |
📝 Summary Table
Parameter | Details |
|---|---|
What | Maternal blood protein produced by placenta |
Why | Screen for chromosomal abnormalities (esp. Trisomy 21) |
Test Timing | 11–13+6 weeks gestation |
Normal Range | >1.0 MoM |
Low PAPPA | ↑ Risk for Down syndrome, preeclampsia, IUGR |
Follow-up Tests | β-hCG, NT scan, NIPT, CVS, Quad test |
Associated Conditions | Aneuploidy, placental insufficiency, adverse pregnancy outcomes |
Fasting Required | ❌ No |
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