Low PAPP-A and failure to grow? Also, Tdap booster @28 weeks « Back to Group Discussions

[midsummer]

Hi everyone,

I tested low on my PAPP-A levels during the first trimester blood screening (when they also test hcg). The low levels triggered a really high probability of down's syndrome, and we were lucky enough to do the Verifi test and determine that we are negative for down's. Now that I'm further along, I guess the latest trouble with the low PAPP-A is that it is supposed to be correlated with 'failure to grow,' and one of my providers wants to do extra ultrasounds at 28 and 36 weeks to check on the baby's growth. Has anyone ever encountered this and if so, did you go along with the extra ultrasounds? I am not worried about the ultrasounds as much as I am worried that this provider is slowly pushing us into a more and more monitored birth process-- we hope to have a homebirth with another provider, but this is with my HMO who sees me and would be the provider if we did have to have a hospital birth. 

Also, the HMO wants to give me a Tdap/ pertussis vaccination booster at 28 weeks to 'transfer immunity to the baby.' I know there are a lot of different opinions and strategies for vaccination out there but is anyone else trying to make up their minds on this one? Is this common? 

Thank you. 

[dayiscoming2006]

I've never heard of getting a booster of any sort during pregnancy. Seems really weird to me. I don't trust vaccines at all what-so-ever, but would absolutely not take a chance of doing them during pregnancy. Do your research and come to your conclusions, but that's my strong opinion.

As far as the ultrasounds, I don't know too much about all of that. Were you able to run that stuff by the homebirth midwife and did she have an opinion on it all? I don't like the sound of your provider by the way you described them here and in the weight gain thread. I'd probably drop them personally, unless you lack any other options. 

[InLove2009]

I will have to have an extra ultrasound at 27 and 32 weeks. My provider is also worried about the babies growth, but because I have Rheumatoid Arthritis. I am not really worried about the extra ultrasounds. I rather have them and have them tell me that everything is ok, than not to have them and something is wrong and we don't know.

 I have not heard of getting a booster during pregnancy. I would think that if they are worried about you passing pertussis to your baby, they could still give you the shot AFTER you give birth and you would transfer the antibodies through your breastmilk. I would do some research on it. And like dayiscoming suggested, ask your other midwife for her opinion before you agree to anything. 

[rainbownurse]

Does your other midwife know about the low Papp-A? 
Did the doctor explain the other risks associated with that? How low is it? less than 0.5? less than 0.3? 
I think you really need to speak the midwife for the homebirth about the low Papp-A levels. From my understanding, depending on how low the Papp-A is, it could mean that you shouldn't be having a home birth. 

Again, this is just my understanding, and I am not your health care provider, nor do I know what your levels are. I think it's a discussion you should be having with your hb midwife.
As for the booster, I've never heard of it, and don't think it's a good idea. 
The ultrasounds are a good idea, in my opinion. 

[Tenk]

I'm not a medical person, have no training etc BUT I do have to have a lot of ultrasounds during pregnancy and have with my last 4 pregnancies.  It's never been a problem in anyway at all.  RainbowNurse does have knowledge of medical stuff and I'd second her regarding discussing the severity of the low levels with your midwife.  Also, I would NEVER allow someone to give me a vax while pregnant such as that but my children are not completely vax'd either.  It's your call.  Do your research on this particular vax during pregnancy and see what studies are out there, if there are none, do you really want to take that chance or be the guninpig?  Good luck mama!!
 

[midsummer]

Thanks, everyone. I was kind of overwhelmed by that appointment but I am lucky that my homebirth midwife has been really attentive to anything risky... the PAPP-A levels are low, and she wants to keep a close eye on the placenta and cord for any potential growth issues (or pre-eclampsia or other complications) but right now she feels pretty confident that I am safe to go ahead with a homebirth. It will really depend on the last few weeks, though. I imagine the extra ultrasounds will help us know whether I am on track.

I think it was more the combination of the HMO midwife wanting to see me twice as often as we'd agreed plus urging me to get this vaccination plus the extra ultrasounds plus (as I wrote in another thread) there were some off hand comments about my weight that threw me off. It just felt really overwhelming. I felt like I was getting sucked into a more intensive medical machine and wasn't sure which of the interventions I was okay with. I will talk more with my homebirth midwife and we will see what she thinks. I am lucky that I have another care provider who I trust more!

I am suspicious of this extra vaccine though... I think it's a run-around because so many Portland are mamas are choosing not to do infant vaccinations, perhaps? (I'm in Oregon). Thanks for all your comments, they helped me start to figure out why I was so overwhelmed. 

[rainbownurse]

I would imagine it's very easy to feel overwhelmed! I hope all my questions didn't make you feel more overwhelmed. It was more supposed to be questions for you to ask, so you can get all the right information. 

It sounds like your homebirth midwife is on the right track, and I'm really glad you have a provider you like and trust, it makes a world of difference. 

[lolliegee]

I've been there with dual care, where one was way more "medical" than the other. It can be very frustrating and overwhelming! I'm sorry the one midwife seems like such a (trying to think of polite way of putting it, how does this group feel about bad language? :0P) stinker. She sounds awful.

I'm with the others on the vaccine. I'm also from Oregon (the Eugene area) and you could be right about why they're pushing you to get the booster. Man though, the more I read about vaccines, the less I trust them. I just read an interesting article correlating vaccines with the rise in peanut allergies. Pretty fascinating.

As for the ultrasounds, I too have had to have multiple ones due to being diabetic. I've always been okay with them because I see the need. Sometimes they're necessary.

[midsummer]

Originally Posted by rainbownurse 

Does your other midwife know about the low Papp-A? 
Did the doctor explain the other risks associated with that? How low is it? less than 0.5? less than 0.3? 

Hi rainbownurse, thanks for these questions. As you can imagine I have done a bunch of research on PAPP-A and generally have ended up feeling like there isn't a lot of good information out there, at least accessible to me. The HMO midwife said she's never had any patients who have had complications, I found more information as I did the research, although I also talked with the high-risk drs when they first told me about the test. In my research, I found a 4% increased risk for various complications (pre-eclampsia etc) from one source but do you know if the complications end up corresponding to the level of PAPP-A? I was tested at .38 mom. I don't know if that means I am at more risk than someone at .5. Anyway, questions to definitely follow up with the other midwife--we've talked about it but not in super great detail. If you have good sources of information I would love to read that as well!

Thanks for your help. 

[rainbownurse]

What I've read is not super consistent, and to be perfectly honest I found it really hard to read. I did find a good article at work through the work subscriptions. When I'm back on Wednesday I'll see if I can find it and send it to you.
Any kind of "low" blood work always depends on how low it is, and how they measure it. From what I can understand, they measure papp-a kind of strangely. I think they measure it as how far it is from the median, but in my head the more levels the have, the more the median would change. 
Anyhow, when I get back to work I'll look up the article. Your homebirth midwife seems to be very rational and has a good head on her shoulders

[Ruheling]

Re the pertussis vaccine, I'm pretty sure that they're encouraging boosters for all - in light of recent (scary) outbreaks.