{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:36:55Z","timestamp":1792809415431,"version":"4.5.0"},"reference-count":43,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:00:00Z","timestamp":1792713600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:00:00Z","timestamp":1792713600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the effectiveness of low\u2010dose aspirin in the prevention of recurrent preterm birth (PTB) in women with signs of maternal vascular malperfusion (MVM) in the placenta of the previous spontaneous PTB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Secondary analysis of the APRIL study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The APRIL study, conducted in 34 centres in the Netherlands, evaluated low\u2010dose aspirin versus placebo in the prevention of recurrent PTB after spontaneous PTB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>Women with a history of spontaneous PTB participating in the APRIL study, with available placenta histology reports from the previous spontaneous PTB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Placental histology reports were retrieved from participating centres and categorized for presence of MVM as defined by the Amsterdam criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Recurrent PTB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Placental histology reports of the previous spontaneous PTB were available for 41.3% (160\/387) of participants, and MVM was present in 27.5% (44\/160). In participants with MVM, recurrent PTB occurred in 4.2% (1\/24) of the aspirin group, versus in 45.0% (9\/20) in the placebo group (Relative Risk (RR) 0.09; 95% Confidence Interval (CI) 0.01\u20130.43;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). In participants without MVM, PTB occurred in 29.3% (17\/58) in the aspirin group compared to 17.2% (10\/58) in the placebo group (RR 1.70; 95% CI 0.87\u20133.56;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.13).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In women with a history of spontaneous PTB and signs of MVM in the placenta, a vascular\u2010mediated subgroup, the use of low\u2010dose aspirin in a subsequent pregnancy was associated with a lower rate of recurrent PTB.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.70350","type":"journal-article","created":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:42:06Z","timestamp":1792806126000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Low\u2010Dose Aspirin in the Prevention of Recurrent Spontaneous Preterm Birth Stratified by Placental Maternal Vascular Malperfusion: Secondary Analysis of a Randomized Trial"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7948-6022","authenticated-orcid":false,"given":"James A. L.","family":"Meli\u00ebzer","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Amsterdam UMC Vrije Universiteit Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6354-3489","authenticated-orcid":false,"given":"Anadeijda J. E. M. C.","family":"Landman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Amsterdam UMC Vrije Universiteit Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelia A.","family":"Gieskes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Amsterdam UMC Vrije Universiteit Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7689-3042","authenticated-orcid":false,"given":"Marianna","family":"Bugiani","sequence":"additional","affiliation":[{"name":"Department of Pathology, Amsterdam UMC Vrije Universiteit Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7670-9305","authenticated-orcid":false,"given":"Laura","family":"Visser","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Amsterdam UMC Vrije Universiteit Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7372-4291","authenticated-orcid":false,"given":"Mireille N.","family":"Bekker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University Medical Centre Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith O. 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H.","family":"van Laar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Maxima Medical Centre  Veldhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke","family":"Sueters","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Leiden University Medical Centre  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanne J.","family":"Gordijn","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University Medical Centre Groningen University of Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4592-4288","authenticated-orcid":false,"given":"Joris","family":"van Drongelen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Radboud University Medical Centre  Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Marko","family":"Sikkema","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Hospital Group Twente Almelo  Almelo the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wietske","family":"Hermes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Haaglanden Medical Centre  Den Haag the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjoke J. M.","family":"Huisjes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Gelre Hospitals Apeldoorn  Apeldoorn the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitri N. M.","family":"Papatsonis","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Amphia Hospital  Breda the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janine","family":"Boon","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Diakonessenhuis  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joost J.","family":"Zwart","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Deventer Hospital  Deventer the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3277-2542","authenticated-orcid":false,"given":"Christianne J. M.","family":"de Groot","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Amsterdam UMC Vrije Universiteit Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn A.","family":"Oudijk","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Amsterdam UMC Vrije Universiteit Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjon A.","family":"de Boer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Amsterdam UMC Vrije Universiteit Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,23]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2393-10-S1-S1","article-title":"Global Report on Preterm Birth and Stillbirth (1 of 7): Definitions, Description of the Burden and Opportunities to Improve Data","volume":"10","author":"Lawn J. 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