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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
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Poster Session 3

(726) Placenta accreta spectrum is associated with lower rates of hypertensive disorders of pregnancy

Friday, January 31, 2025
10:30 AM – 12:30 PM  
Objective: Placenta accreta spectrum (PAS) arises from over-invasion of the placenta, while hypertensive disorders of pregnancy (HDP) are thought to arise from trophoblast under-invasion; these may represent two ends of a spectrum of disordered placentation. In a single-institution study, we previously demonstrated clinical evidence suggesting PAS is protective against HDP. Here, we validated this finding in a larger patient cohort.

Study Design: This retrospective study utilizes Epic Systems’ Cosmos research platform, an electronic health record database with de-identified patient-level data. PAS, HDP (gestational hypertension, preeclampsia, eclampsia, and HELLP) and other clinical and sociodemographic characteristics were extracted from the database for all deliveries from 2017-2023. Patients with and without HDP were compared across a range of maternal attributes. To account for scheduled preterm deliveries for PAS, such that some patients with PAS deliver before HDP is clinically diagnosed, these comparisons were repeated with cohorts stratified by gestational age (GA) at delivery (< 34 weeks and ≥ 34 weeks). For all cohorts, the crude and adjusted odds of HDP by PAS diagnosis was calculated using logistic regression. All covariates in the bivariate tests of association were included in the multivariable regression models.

Results: A total of 4,287,549 delivery encounters were included. Of those, 8,979 (0.21%) had PAS, 869,759 (20.3%) had HDP, and 125,332 deliveries (2.9%) occurred < 34 weeks. In the total cohort, after adjusting for GA at delivery and maternal factors, patients with PAS were half as likely to be diagnosed with HDP (aOR 0.55 [0.51, 0.59]). In both GA-stratified cohorts, < 34 weeks and ≥34 weeks, this effect remained stable with aOR 0.54 [0.47, 0.62] and aOR 0.42 [0.38, 0.45], respectively.

Conclusion: Patients with PAS develop HDP at half the rates seen in those without PAS after controlling for GA at delivery and patient factors. These two seemingly unrelated conditions may result from abnormalities of the same biologic mechanisms and may benefit from future tandem investigation.