{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T10:28:31Z","timestamp":1781173711793,"version":"3.54.1"},"reference-count":47,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate school performance at 12\u2009years of age in children prenatally exposed to maintenance tocolysis with nifedipine versus placebo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>\n                      12\u2010year follow\u2010up of the multicentre APOSTEL 2 trial, in which participants with threatened preterm birth between 26\n                      <jats:sup>+0<\/jats:sup>\n                      and 32\n                      <jats:sup>+2<\/jats:sup>\n                      weeks of gestation, who remained pregnant after initial 48\u2010h tocolysis, were randomised to nifedipine maintenance tocolysis or placebo for up to 12\u2009days.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The APOSTEL 2 trial was conducted in 11 Dutch hospitals from 2008 to 2010. School outcomes were assessed at age 12.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Children from singleton and multiple pregnancies born to APOSTEL 2 participants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      <jats:bold>S<\/jats:bold>\n                      chool performance data were received through linkage with a national registry (Statistics Netherlands).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>A high track recommendation for secondary school, adjusted for maternal education level, socioeconomic status, and child's biological sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 492 eligible children, 357 were included (follow\u2010up rate 73%). In the nifedipine group, significantly fewer children received a high track recommendation for secondary school, 67\/189 (35.4%), compared to 74\/168 (44.0%) in the placebo group (adjusted risk ratio (aRR) 0.76; 95% confidence interval (CI) 0.61\u20130.95). Outcomes were significantly poorer in children with the longest nifedipine exposure (9\u201314\u2009days) compared to those not exposed (aRR 0.58; 95% CI 0.41\u20130.83).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Children prenatally exposed to maintenance tocolysis with nifedipine had significantly poorer school performance at 12\u2009years of age compared to those exposed to placebo. These findings further discourage nifedipine's use for maintenance tocolysis, and more research is warranted regarding its long\u2010term effects on child development.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.70030","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T08:51:00Z","timestamp":1759135860000},"page":"334-344","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["School Performance After Maintenance Tocolysis With Nifedipine for Threatened Preterm Birth: 12\u2010Year Follow\u2010Up of the\n                    <scp>APOSTEL<\/scp>\n                    2 Trial"],"prefix":"10.1111","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8443-1702","authenticated-orcid":false,"given":"Larissa I.","family":"van der Windt","sequence":"first","affiliation":[{"name":"Amsterdam UMC Location University of Amsterdam Department of Obstetrics and Gynaecology  Amsterdam the Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7948-6022","authenticated-orcid":false,"given":"Jim A. 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A.","family":"Spaanderman","sequence":"additional","affiliation":[{"name":"Maastricht University Medical Centre Department of Obstetrics and Gynaecology  Maastricht the Netherlands"},{"name":"GROW, Research Institute for Oncology and Reproduction Maastricht University  Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hubertina C. 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