Every year, nearly 4 million babies are born in the United States. About 50,000 of these births are complicated in ways that could endanger the baby’s life, and up to 900 mothers die during delivery.
Placenta accreta spectrum (PAS) is a serious risk to both the mother and the child during pregnancy. Ultrasounds, MRIs, and predicted confounding factors are now used to identify PAS patients; nonetheless, between 33 and 50 percent of PAS cases go unnoticed until after birth.
In a new study, researchers from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, tried to find a way to predict PAS during pregnancy. This would help both patients and doctors be better prepared for the day of delivery.
By looking at pregnant women’s circulating microparticle (CMP) protein panels, the team found five unique CMP proteins that can predict PAS as early as the second trimester. Their findings have been published in Scientific Reports.
“PAS is a significant contributor to maternal morbidity and mortality worldwide,” says corresponding author Hope Yu. “Before our study, up to half of these cases weren’t able to be detected before delivery. Our study aims to improve that detection rate using a blood test and to eventually improve health outcomes worldwide.”
Placenta accreta is a condition in which the placenta becomes abnormally attached to the uterine wall. This condition is referred to as being part of the “spectrum” because the degree of penetration of the placenta into the uterine wall can vary.
Placenta accreta can range in severity. In some cases, the placenta becomes attached to the uterine muscle. In more severe cases, the placenta can attach not only to the uterine wall but also to other organs, such as the bladder.
Patients with placenta accreta spectrum (PAS) are at risk for two major complications: difficulty delivering the placenta after birth and heavy bleeding. Identifying PAS before delivery can help mitigate these risks and allow for appropriate medical preparations.
The researchers at Brigham analyzed proteins linked to CMPs in an effort to detect PAS at an early stage. CMPs are small extracellular vesicles that cells use to talk to each other. They have been studied a lot in other fields because they show how cells talk to each other.
The research team aimed to study placental mesenchymal cells (CMPs) at the boundary between the mother and fetus, with the aim of identifying a biomarker for placenta accreta spectrum (PAS) that could be used in clinical practice, and to investigate how CMPs contribute to the development of PAS. The primary goal of the team was to develop a blood test that could be used to diagnose PAS in pregnancy.
The research team conducted a study involving 35 patients with placenta accreta spectrum (PAS) and 70 control patients. All of the patients in the study were diagnosed with PAS or served as controls after delivery.
Plasma samples taken from pregnant women during their second and third trimesters were used to find and isolate CMP proteins.
The research team collected samples from patients who were 26 and 35 weeks pregnant. They found that five placental mesenchymal cell (CMP) proteins could distinguish PAS patients from control patients when the samples were taken at 26 weeks, and four CMP proteins could distinguish PAS patients from control patients when the samples were taken at 35 weeks.
The research team also found that in the second trimester, there were abnormal levels of proteins involved in iron balance and the signaling of erythropoietin. In the third trimester, this trend continued and was accompanied by abnormal immune function.
The study was able to find five CMP protein PAS indicators in the second trimester and four in the third trimester. This means that PAS can be safely predicted well before delivery.
The authors point out that further studies and clinical trials will be required to examine the protein panel’s applicability in more detail. The next steps are to increase the number of patients in the sample and make a standard commercial test.
Source: 10.1038/s41598-022-24869-0
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