Biomarkers of abnormally invasive placenta

Abnormally invasive placenta (AIP, aka placenta accreta spectrum; PAS) is an increasingly common pregnancy pathology, which, despite significant morbidity risk to the mother, is often undiagnosed prior to delivery. We tested several potential biomarkers in plasma from PAS mothers to determine whether any were sufficiently robust for a formal, diagnostic accuracy study. We examined hyperglycosylated hCG (h-hCG), decorin and IL-8, based on biological plausibility and literature indications that they might be altered in PAS. These analytes were assayed by ELISA in maternal plasma from five groups, comprising (1) normal term controls, (2) placenta previa controls, and cases of (3) placenta increta/percreta without placenta previa, (4) placenta previa increta/percreta and (5) placenta previa accreta. There were no differences in h-hCG, ß-hCG or the h-hCG/ß-hCG ratio between the groups. Mean decorin levels were increased in previa controls (Group 2) compared to the other groups, but there was substantial overlap between the individual values. While an initial multiplex assay showed a greater value for IL-8 in the placenta previa increta/percreta group (Group 4) compared to placenta previa controls (Group 2), the subsequent validation ELISA for IL-8 showed no differences between the groups. We conclude that the absence of differences and the extent of overlap between cases and controls does not justify further assessment of these biomarkers. •We lack biomarkers which can identify abnormally invasive placenta (placenta accreta).•There is evidence that hyperglycosylated hCG, decorin and IL-8 may act as biomarkers.•Maternal plasma h-hCG, decorin and IL-8 concentrations were measured in abnormally invasive placenta (AIP).•None of these molecules showed sufficient differentiation between cases and controls to permit use as biomarkers.