Objective: To investigate whether first trimester low PAPP-A levels are associated with adverse pregnancy outcomes. Methods: A case control retrospective study including 663 pregnant women whose gestational age ranged between 11 and 14 weeks attending prenatal care at Akdeniz University Hospital was carried out. Chromosomal abnormalities, spontaneous abortions, and multiple pregnancies were excluded from the study. Finally 318 singleton pregnancies were included in this study. Pregnant women whose PAPPA levels were ≤ 10th percentile were compared with PAPP-A levels > 10th percentile for the frequency of pregnancy complications such as SGA, preeclampsia, preterm delivery, gestational diabetes mellitus and gestational hypertension. Results: The most common complication of pregnancy was SGA (9.4%, n = 30). There was no significant association between low PAPP-A levels and incidence of subsequent pregnancy outcomes. Maternal age was found to be a risk factor for gestational diabetes (p = 0.00). Small for gestational age was significantly associated with nulliparity and smoking during pregnancy (p = 0.03 and p = 0.01, respectively). Conclusion: First trimester of low PAPP-A level (≤ 10th percentile) was not associated with SGA, preeclampsia, preterm delivery, gestational hypertension or gestational diabetes mellitus.