Evaluation of maternal serum protein biomarkers in the prenatal evaluation of placenta accreta spectrum: A systematic scoping review

• Published in: Acta obstetricia et gynecologica Scandinavica 2024-12, Vol.103 (12), p.2335-2347
• Main Authors: Givens, Matthew, Valcheva, Ivaila, Einerson, Brett D., Rogozińska, Ewelina, Jauniaux, Eric
• Format: Article
• Language: English
• Subjects: Biomarkers; Biomarkers - blood; Blood Proteins - analysis; Female; Humans; maternal serum; placenta accreta; Placenta Accreta - blood; Placenta Accreta - diagnosis; placenta accreta spectrum; placenta previa accreta; Pregnancy; Pregnancy complications; Prenatal Diagnosis - methods; protein biomarkers; screening; Systematic Review
• ISSN: 0001-6349; 1600-0412; 1600-0412
• DOI: 10.1111/aogs.14918

Introduction Placenta accreta spectrum (PAS) is an increasingly commonly reported condition due to the continuous increase in the rate of cesarean deliveries (CD) worldwide; however, the prenatal screening for pregnant patients at risk of PAS at birth remains limited, in particular when imaging expertise is not available. Material and Methods Two major electronic databases (MEDLINE and Embase) were searched electronically for articles published in English between October 1992 and January 2023 using combinations of the relevant medical subject heading terms and keywords. Two independent reviewers selected observational studies that provided data on one or more measurement of maternal blood‐specific biomarker(s) during pregnancies with PAS at birth. PRISMA Extension for Scoping Review (PRISMA‐ScR) was used to extract data and report results. Results Of the 441 reviewed articles, 29 met the inclusion criteria reporting on 34 different biomarkers. 14 studies were retrospective and 15 prospective overall including 18 251 participants. Six studies had a cohort design and the remaining a case–control design. Wide clinical heterogeneity was found in the included studies. In eight studies, the samples were obtained in the first trimester; in five, the samples were collected on hospital admission for delivery; and in the rest, the samples were collected during the second and/or third trimester. Conclusions Measurements of serum biomarkers, some of which have been or are still used in screening for other pregnancy complications, could contribute to the prenatal evaluation of patients at risk of PAS at delivery; however, important evidence gaps were identified for suitable cutoffs for most biomarkers, variability of gestational age at sampling and the potential overlap of the marker values with other placental‐related complications of pregnancy. Measurements of serum protein biomarkers which have been or are still used in screening for fetal aneuploidy, fetal neuro‐tubal defects, fetal growth restriction, and preeclampsia may contribute to prenatal evaluation of patients at risk of placenta accreta spectrum at delivery but should be evaluated prospectively in case‐control studies matched for gestational age at sampling.