I have low PAPP-A.

My combined screening results during my 12-week scan came back a week or so ago. This time, I was not in the high-risk category for any trisomy (21, 18, or 13: Down’s, Edward’s, or Patau’s Syndrome), unlike my pregnancy with my daughter. Honestly, I thought that with my “advanced” maternal age of 36 and my previous risk levels, I’d be the same, maybe even worse. So this was a relief. However, a new concern popped up: my low number for Pregnancy Associated Plasma Protein-A.

What’s PAPP-A? According to the NHS, PAPP-A is a hormone that is made by the placenta in pregnancy. Its measurement as part of the combined screening blood test can help to determine if a mother might be at risk for certain problems. Low PAPP-A numbers may be associated with a lower birth weight baby (as the placenta might not be working as well as it should), an increased chance of having an early birth, miscarriage in the second half of pregnancy, or an increased chance of developing pre-eclampsia. Every one of those problems is hella scary. “Lower birth weight baby” means probable NICU-fattening-up-time. “Early birth” equals preemie baby (again, NICU time). “Late miscarriage” means stillbirth. And pre-eclampsia is when the mother develops high blood pressure in pregnancy which may lead to damage to other organs (kidneys or liver) and ultimately the need to deliver the baby early. Holy cow.

Then again, low PAPP-A doesn’t necessarily mean any of those complications will happen.

When I first read the results letter, I was confused. This sounded like a big deal, so why wasn’t it delivered via a phone call like other complications? Why was my follow-up phone appointment with a consultant obstetrician to “talk it over” a month away? And, actually, was this a big deal?

When I called my midwife team, I received heartening news. Yes, my number is low, but it doesn’t prove anything is wrong. The majority of women diagnosed with low PAPP-A numbers deliver healthy, full-term babies. It’s just a measurement used to keep track of any potential problems, especially after the 28th week. Apparently, that’s when the baby might not be growing as well as he or she should. That’s 13 weeks away.

Additional ultrasounds and check-ups are already in the works for me. They want to keep a close eye on my progress, something I experienced during my daughter’s pregnancy and to which I was happy to oblige. As an added measure, they want me to start taking 150mg of aspirin a day to help blood flow to the placenta. More blood equals more nutrients equals happier baby.

I wasn’t nervous when I hung up – the midwife stressed that baby was right on track during my appointment, and I definitely saw him/her wriggling around like crazy during the ultrasound – but I found comfort in knowing I could physically do something to make a difference in this pregnancy. Taking low-dose aspirin may not seem like a big deal, but the act of popping those two pills every morning gives me the tiniest feeling of control in a situation that is mostly out of my hands. I know that what will be, will be. Life is like that. But I’m also going to do everything I can to stack the odds in my favor.

Switching topics, house stuff is oh-so-close to being done. Or so we think. We’ve just been waiting on a few answers to a few questions for a week or so now. Our lawyer has our money. She has our contract. She has all the requested surveys and guarantees. We’re just waiting on the seller. Man, is it annoying to not know our move-in date. Especially as we have other plans in place. Things like, I don’t know, a preschool start date, a new job for my husband, and a requirement for me to figure out which hospital I’ll switch to so I can move all my antenatal appointments over. I guess when we decide to embark on major life events, we do them all at once.

And in toddler breaking news, I think we’re approaching the beginning of the end of potty training. Yes, I said it. Don’t get me wrong, she still pees her pants on a semi-regular basis (normally when she’s engaged in some activity much more appealing than sitting on the toilet, like playing with her dump truck or putting rocks in the dog’s water), but she’s actually quite good now. During her last few weeks of nursery, she even had entire days where she wouldn’t have an accident. She’ll sometimes say “Pee!” when she has to go and is very capable of holding it for longer periods now. We’ve also had a few poop wins. Mostly down to good luck, but I’ll count it. She quite happily pooped her pants since we started potty training as a fun experiment in lockdown (“fun”), and we’ve mostly just had to accept it. We’ve kept up our putting-her-on-the-potty routine, but it’s been frustrating when she then goes five minutes after taking her off. But the past week has given us hope. She’s beginning to tell us she needs to poop before she’s actually gone, which is amazing. Even the false alarms – the times she thinks a fart is a poo, or more recently, a burp – are causes for excitedly rushing her to the toilet to try. I’m convinced that it’ll click one day soon. Barring that, preschool should offer her enough peer pressure that she’ll realize poo-pants isn’t a great option for humans.

We can only hope.

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