{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T09:26:39Z","timestamp":1789550799321,"version":"build-2803163510"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Placenta accreta spectrum (PAS) disorders are a series of gestational diseases, with severe adverse outcomes. Apolipoprotein A1 (APOA1) is a lipid molecule that plays a role in cell invasion, inflammation and immune response. This study aimed to elucidate the relationship between APOA1 and PAS, as well as its adverse outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a nested case-control study involving 118 patients with PAS and 118 non-PAS control women. Plasma APOA1 levels were evaluated at gestational weeks 24<jats:sup>+0<\/jats:sup> to 35<jats:sup>+6<\/jats:sup> by enzyme-linked immunosorbent assay. The clinical characteristics and pregnancy outcomes were recorded and analyzed in relation to APOA1 levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The plasma APOA1 level in the PAS group was observed to be lower than that in the non-PAS group (<jats:italic>p<\/jats:italic> = 0.035). From 24<jats:sup>+0<\/jats:sup> to 35<jats:sup>+6<\/jats:sup> weeks of gestation, the trajectory of plasma APOA1 levels in the placenta percreta (PP) and placenta increta group exhibited a discernible decline. Maternal plasma APOA1 is a significant biomarker for the diagnosis of PAS and its adverse outcomes, particularly in the 32<jats:sup>+0<\/jats:sup> to 35<jats:sup>+6<\/jats:sup> weeks of gestation range for invasive PAS (AUC\u00a0= 0.761, 95% CI 0.660-0.863, <jats:italic>p<\/jats:italic>\u00a0&amp;lt;\u00a00.001), PP (AUC = 0.889, 95% CI 0.801-0.976, <jats:italic>p<\/jats:italic>\u00a0&amp;lt; 0.001), blood transfusion (AUC = 0.729, 95% CI 0.620-0.838, <jats:italic>p<\/jats:italic> &amp;lt; 0.001) and hysterectomy (AUC = 0.884, 95% CI 0.790-0.978, <jats:italic>p<\/jats:italic> &amp;lt; 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A reduction in maternal plasma APOA1 levels was associated with the severity of PAS. APOA1 may serve as a biomarker for invasive PAS, blood transfusion and hysterectomy in late gestation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1627377","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T04:10:44Z","timestamp":1753330244000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Decreased plasma APOA1 levels are associated with increased severity of placenta accreta spectrum disorders: a nested case-control 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