Elabela as a predictive biomarker for placenta accreta spectrum: a case-control study

To evaluate maternal serum Elabela (ELA) levels in pregnancies complicated by placenta accreta spectrum (PAS) and to assess their association with disease severity and predictive value for adverse obstetric outcomes.

In this prospective case-control study conducted at the Department of Perinatology, Ankara Etlik City Hospital (Türkiye) between February and July 2025, 88 pregnant women were included: 44 with PAS and 44 healthy controls matched for maternal age and gestational age. Maternal serum ELA levels were measured using a commercially available ELISA kit. Demographic, obstetric, clinical, and perinatal data were recorded. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic performance of ELA, and logistic regression was used to evaluate its predictive value for PAS.

Median ELA levels were significantly higher in the PAS group compared to controls (2600.38 [2419.52-2700.75] vs. 2359.65 [2249.25-2490.63] pg/mL; p < 0.001). The area under the ROC curve was 0.721 (p < 0.001; 95% CI: 0.615-0.811). The optimal cut-off value of 2488.75 pg/mL predicted PAS with 70.5% sensitivity, 75.0% specificity, a positive likelihood ratio of 2.82, and a negative likelihood ratio of 0.39.

Elevated maternal serum ELA levels are associated with PAS and may serve as a potential biomarker for its prenatal identification. Further large-scale prospective studies are warranted to confirm its diagnostic utility and to explore its role in disease pathophysiology.