Does very low papp a lead to poor pregnancy outcomes in chromosomally normal pregnancies? What might a course of monitoring/treatment look like?

Need close attention. The low papp-a result is an indicator for increased risk of genetic anomalies. It is reassuring if you have had a karyotype that showed nomal chromosomes. The pregnancy is still at an increased risk for miscarriage, preterm labor and delivery, poor fetal growth, and fetal demise. Increased fetal surveillance throughout the pregnancy.
Slight risk. A low papp-a level in pregnancy is associated with intrauterine growth restriction (iugr) and preeclampsia. Your OB will schedule serial ultrasounds (q 4-6 weeks) to ensure proper fetal growth & educate you on the signs & symptoms of preeclampsia. I've found many patients with a low level & not any who've had problems with their pregnancy. Make sure & keep your appointments, you'll be fine.