The potential risk factors of placenta increta and the role of octamethylcyclotetrasiloxane

Background The study aimed to investigate the potential risk factors for the placenta accreta spectrum (PAS), determine the predictive value of a diagnostic model, and evaluate the effects of octamethylcyclotetrasiloxane (OMCTS) on trophoblast proliferation and migration. Methods This case-control study included 244 pregnant women with PAS and 327 normal pregnant women who visited Guangzhou Women and Children's Medical Centre, China, from January 2014 to December 2017. Blood was collected from 42 women with PAS and 77 controls, and plasma specimens were analyzed by gas chromatography-time-of-flight mass spectrometry. In addition, the proliferation and migration of trophoblast cells were examined after treatment with OMCTS. Results We found an association between the risk of PAS and clinical factors related to fasting blood glucose levels (BS0, OR = 5.78), as well as factors related to endometrial injury [history of cesarean section (OR = 179.59), uterine scarring (OR = 68.37), and history of abortion (OR = 5.66)]. Equally important, pregnant women with PAS had significantly higher plasma OMCTS concentrations than controls. In vitro, we found that OMCTS could promote the proliferation and migration of HTR8/SVneo cells. The model of combining clinical factors and OMCTS had a good performance in PAS prediction (AUC = 0.97, 95% CI 0.78-0.93). Conclusions The early diagnosis of PAS in pregnant women requires assessing risk factors, metabolic status, and BS0 levels before 20 weeks of gestation. OMCTS may be related to the development of PAS by promoting trophoblast cell proliferation and migration.

Automated summary

This study identified potential risk factors for the placenta accreta spectrum (PAS) and highlighted the association between PAS risk and factors such as fasting blood glucose levels, history of endometrial injury, and plasma octamethylcyclotetrasiloxane (OMCTS) concentrations. Additionally, the study showed that OMCTS may promote trophoblast cell proliferation and migration, and a diagnostic model combining clinical factors and OMCTS had a high predictive value for PAS. Early diagnosis of PAS in pregnant women should involve evaluation of risk factors, metabolic status, and fasting blood glucose levels before 20 weeks of gestation.