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Abstract Placenta Accreta Spectrum (PAS) and pre-eclampsia are obstetric disorders associated with significant maternal morbidity and mortality. As pre-eclampsia is characterised by shallow placental invasion and PAS by abnormally deep invasion, we sought to compare the biological processes dysregulated in PAS to those reported in pre-eclampsia. We demonstrate that many of the processes contributing to unregulated placental invasion in PAS are the mirror findings of those previously reported in pre-eclampsia. These comparisons of PAS to a more common obstetric condition allow a greater understanding of the biological processes contributing to PAS, which remains a very rare obstetric complication.