Update on Trends in Placenta Accreta Syndrome and Its Impact on Maternal-Fetal Morbidity in the United States.

Abstract

Background: Placenta accreta spectrum (PAS) is a life-threatening obstetric condition characterized by abnormal placental adherence to the uterine wall, leading to severe maternal morbidity and mortality. Rising cesarean delivery rates have contributed to its increasing prevalence, yet recent national data on PAS trends and disparities remain limited. This study provides updated estimates of PAS prevalence, racial and geographic disparities, and associated maternal-fetal outcomes using a large, nationally representative dataset from 2016 to 2022.

Method: We conducted a retrospective cross-sectional analysis using the Nationwide Inpatient Sample (NIS), capturing 27,339,861 pregnancy-related hospitalizations. PAS cases (n = 36,310) were identified using International Classification of Disease, Tenth Revision, codes. Temporal trends were assessed using joinpoint regression. Survey logistic regression models estimated associations between PAS and maternal-fetal outcomes, adjusting for demographic, clinical, and hospital factors.

Results: PAS prevalence increased significantly between 2016 and 2022 (annual percent change: 2.9%, p < 0.05), with notable increases among Black and White individuals. PAS was strongly associated with prior cesarean delivery, placenta previa, advanced maternal age, and comorbidities including hypertension, diabetes, and obesity. PAS significantly increased the risk of severe maternal morbidity, including hysterectomy (adjusted odds ratio [aOR] range: 52.2-151.3), blood transfusion (aOR range: 4.3-7.1), and preterm birth (aOR range: 2.4-3.2).

Conclusions: These findings highlight the growing burden of PAS and the urgent need for prevention strategies, such as reducing unnecessary cesarean deliveries, promoting vaginal birth after cesarean when appropriate, enhancing prenatal screening, and ensuring multidisciplinary care. Addressing racial and geographic disparities in PAS diagnosis and outcomes is essential to improve maternal and neonatal health.