IMR Press / CEOG / Volume 50 / Issue 11 / DOI: 10.31083/j.ceog5011232
Open Access Original Research
Elevated Second Trimester Alpha-Fetoprotein Increases the Risk of Placenta Accreta
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1 The Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao University, 266003 Qingdao, Shandong, China
2 Department of Obstetric, Affiliated Hospital of Jining Medical University, Jining Medical University, 272029 Jining, Shandong, China
*Correspondence: (Dongmei Man); (Shiguo Liu)
Clin. Exp. Obstet. Gynecol. 2023, 50(11), 232;
Submitted: 12 July 2023 | Revised: 10 August 2023 | Accepted: 16 August 2023 | Published: 22 November 2023
(This article belongs to the Special Issue Placental Anomalies and Pregnancy Outcomes)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Placenta previa-accreta constitutes an increasing clinical problem, whose diagnosis remains challenging in obstetrics. The current work aimed to assess whether second-trimester serum alpha-fetoprotein (AFP) amounts are altered in pregnant women with placenta previa-accreta versus control values. Methods: A retrospective chart review was performed for 504 pregnant women treated between 1 January 2016 and 28 February 2021. This cohort included 105 placenta previa-accreta and 122 placenta previa control cases, as well as 277 body mass index (BMI)-matched individuals with healthy pregnancy. The multiple of the median (MoM) for AFP was obtained from clinical records. Results: Markedly elevated MoM for AFP was detected in the placenta previa-accreta group compared with the placenta previa control and healthy pregnant control groups (both p < 0.001). Serum AFP levels had a significant positive association with placenta accreta after adjustment for age, BMI, and gestational week at blood collection (β = 0.60; 95% confidence interval [95% CI]: 0.52, 0.68; p < 0.001). In addition, previous cesarean delivery history (β = 3.41; 95% CI: 2.18, 5.34; p < 0.001) also had a significant association with placenta accreta. Conclusions: Elevated second-trimester serum AFP had a positive association with placenta accreta. Such finding suggests a potential role for AFP in detecting pregnancies at high-risk of placenta accreta. This second-trimester biomarker of AFP may help classify women into the high- and low-risk groups for placenta accreta. In addition, we have validated a previous history of cesarean section as a risk factor for accreta in patients with placenta previa.

alpha-fetoprotein AFP
placenta accreta
second trimester serum

(1) The MoM for AFP is higher in the placenta previa accreta group.
(2) High AFP is positively associated with placenta accreta.
(3) The second-trimester biomarker AFP can be used to predict placenta accreta.

2020YXNS007/Key Research and Development Program of Jining Science
82201876/National Natural Science Foundation of China
2023M731307/China Postdoctoral Science Foundation
JYHL2021MS24/Research Fund for Lin He’s Academician Workstation of New Medicine and Clinical Translation in Jining Medical University
ZR2021QH114/Natural Science Fund project in Shandong province
ZR2021LZY001/Natural Science Fund project in Shandong province
322155/Postdoctoral Program in Affiliated Hospital of Jining Medical University
Fig. 1.
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