Serum Concentration of CRIPTO-1 in Pregnancies Complicated by Placenta Accreta Spectrum

To compare maternal serum CRIPTO-1 concentrations in pregnancies complicated by placenta accreta spectrum (PAS) with those complicated by placenta previa (PP).

We conducted a prospective, cross-sectional, comparative study at a tertiary center in São Paulo, Brazil (August 2022-May 2025). Singleton pregnancies with ultrasound-confirmed PP were included and classified as either PP without accreta or PAS (accreta/increta/percreta) according to standardized imaging criteria and, when applicable, surgical/histopathological confirmation. Maternal venous blood was collected predelivery, and serum CRIPTO-1 concentrations were measured using ELISA (Human CRIPTO SimpleStep ELISA Kit, Abcam). Primary analyses used nonparametric tests for continuous variables and Fisher's exact test for categorical variables. The study was approved by the Research Ethics Committee of the University of São Paulo (CAAE 58202122.8.0000.0065; CAAE 55121422.3.0000.0068).

Forty-three participants were analyzed (PP = 18; PAS = 25). Median serum CRIPTO-1 did not differ significantly between groups (PP: 0.013 pg/mL, IQR: 0.001-0.067 vs. PAS: 0.079 pg/mL, IQR: 0.005-0.360; p = 0.156). PAS was associated with greater blood loss (median 2240 vs. 568 mL; p < 0.001), higher transfusion rate (88.0% vs. 16.7%; p < 0.001), more ICU admissions (68.0% vs. 16.7%; p = 0.002), longer ICU and hospital stays (both p < 0.01), and higher hysterectomy rates (84.0% vs. 5.6%; p < 0.001).

Predelivery serum CRIPTO-1 did not discriminate PAS from PP, possibly reflecting physiological variability at delivery.