{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:50:44Z","timestamp":1791348644908,"version":"4.3.1"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"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":["Acta Obstet Gynecol Scand"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Women with pregestational diabetes mellitus (PGDM) are at increased risk of preeclampsia (PE) and are commonly prescribed aspirin prophylaxis based on clinical risk factors alone. First\u2010trimester screening algorithms may allow a more individualized allocation of aspirin. We aimed to compare the association between three first\u2010trimester aspirin allocation strategies and the incidence of preterm PE in women with PGDM in routine clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>This retrospective multicenter observational cohort study included 519 singleton pregnancies with PGDM managed at six tertiary hospitals in Spain between January 2017 and December 2022. Women were classified according to the strategy used to allocate aspirin prophylaxis: clinical risk factor\u2013based prophylaxis, first\u2010trimester algorithm\u2010based screening without placental growth factor (PlGF), or algorithm\u2010based screening including PlGF. The primary outcome was preterm PE (&lt;37\u2009weeks). Secondary outcomes included overall and severe PE, gestational age at delivery, spontaneous preterm birth, birthweight, small\u2010for\u2010gestational\u2010age infants, and neonatal intensive care unit admission. Multivariable regression models were adjusted for prespecified maternal characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 519 pregnancies, 255 were managed using clinical risk factor\u2013based prophylaxis, 119 using the algorithm without PlGF, and 145 using the algorithm with PlGF. Aspirin was prescribed to 100%, 16.8%, and 28.3% of women, respectively. Preterm PE rates were 4.7%, 5.9%, and 4.2%, respectively. After multivariable adjustment, no statistically significant differences in preterm PE were observed for the algorithm without PlGF (adjusted odds ratio [aOR] 1.89, 95% confidence interval [CI] 0.62\u20135.45) or with PlGF (aOR 1.33, 95% CI 0.41\u20133.91) compared with clinical risk factor\u2013based prophylaxis. Secondary maternal and perinatal outcomes were also comparable across groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In women with PGDM, algorithm\u2010based aspirin allocation strategies were associated with substantially lower aspirin exposure without evidence of increased preterm PE or adverse perinatal outcomes compared with clinical risk factor\u2013based prophylaxis. However, given the observational design, baseline differences, and limited number of events, the study was not powered to demonstrate equivalence or exclude smaller clinically relevant differences. These findings should therefore be considered exploratory and require confirmation in adequately powered prospective studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70363","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:21:09Z","timestamp":1791346869000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["First\u2010trimester aspirin allocation strategies and preterm preeclampsia in women with pregestational diabetes: A national multicenter observational cohort study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4001-2017","authenticated-orcid":false,"given":"Mar\u00eda M.","family":"Goya","sequence":"first","affiliation":[{"name":"Maternal and Fetal Medicine Research Group Vall d'Hebron Research Institute (VHIR), Centres de Recerca de Catalunya (CERCA)  Barcelona Spain"},{"name":"Maternal\u2010Fetal Medicine Unit, Department of Obstetrics Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus  Barcelona Spain"},{"name":"Department of Pediatrics, Obstetrics &amp; Gynaecology, and Preventive Medicine and Public Health Universitat Aut\u00f2noma de Barcelona  Bellaterra Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bego\u00f1a","family":"Vega Guedes","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Department, Complejo Hospitalario Universitario Insular Materno\u2010Infantil, Instituto de Investigaci\u00f3n Sanitaria de Canarias (IISC), Instituto Universitario de Investigaciones Biom\u00e9dicas y Sanitarias (IUIBS) Universidad de Las Palmas de Gran Canaria  Las Palmas de Gran Canaria Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f3nica","family":"Ballesteros P\u00e9rez","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Department Hospital Universitari de Tarragona Joan XXIII  Tarragona Spain"},{"name":"Endocrinology and Nutrition Department, Obstetrics and Ginecology Department Universitat Rovira i Virgili  Tarragona Spain"},{"name":"Endocrinology and Nutrition Department, Obstetrics and Ginecology Department Institut d'Investigaci\u00f3 Sanitaria Pere Virgili  Tarragona Spain"},{"name":"Endocrinology and Nutrition Department, Obstetrics and Ginecology Department Ciberdem  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8104-7326","authenticated-orcid":false,"given":"Ver\u00f3nica","family":"Perea Castilla","sequence":"additional","affiliation":[{"name":"Endocrinology and Nutrition Department Hospital Universitari M\u00fatua Terrasa  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Vinagre Torres","sequence":"additional","affiliation":[{"name":"Diabetes Unit, Endocrinology and Nutrition Department Hospital Cl\u00ednic de Barcelona  Barcelona Spain"},{"name":"Endocrinology and Nutrition Department IDIBAPS (Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Bugatto","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Obstetrics and Gynecology Department Puerta del Mar University Hospital  C\u00e1diz Spain"},{"name":"Department of Child and Mother Health and Radiology, School of Medicine University of C\u00e1diz and Biomedical Research and Innovation Institute of C\u00e1diz (INiBICA)  C\u00e1diz Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana M.","family":"W\u00e4gner Fahlin","sequence":"additional","affiliation":[{"name":"Endocrinology and Nutrition Department, Complejo Hospitalario Universitario Insular Materno\u2010Infantil, Instituto de Investigaci\u00f3n Sanitaria de Canarias (IISC), Instituto Universitario de Investigaciones Biom\u00e9dicas y Sanitarias (IUIBS) Universidad de Las Palmas de Gran Canaria  Las Palmas de Gran Canaria Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Meg\u00eda Colet","sequence":"additional","affiliation":[{"name":"Endocrinology and Nutrition Department, Obstetrics and Ginecology Department Universitat Rovira i Virgili  Tarragona Spain"},{"name":"Endocrinology and Nutrition Department, Obstetrics and Ginecology Department Institut d'Investigaci\u00f3 Sanitaria Pere Virgili  Tarragona Spain"},{"name":"Endocrinology and Nutrition Department, Obstetrics and Ginecology Department Ciberdem  Madrid Spain"},{"name":"Department of Endocrinology and Nutrition Joan XXIII University Hospital  Tarragona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judit","family":"Amig\u00f3 Farr\u00e1n","sequence":"additional","affiliation":[{"name":"Servei d' Endocrinologia i Nutrici\u00f3 Hospital Universitari Vall d'Hebron  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manel","family":"Mendoza","sequence":"additional","affiliation":[{"name":"Maternal and Fetal Medicine Research Group Vall d'Hebron Research Institute (VHIR), Centres de Recerca de Catalunya (CERCA)  Barcelona Spain"},{"name":"Maternal\u2010Fetal Medicine Unit, Department of Obstetrics Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus  Barcelona Spain"},{"name":"Department of Pediatrics, Obstetrics &amp; Gynaecology, and Preventive Medicine and Public Health Universitat Aut\u00f2noma de Barcelona  Bellaterra Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Spanish Diabetes and Pregnancy Group (GEDE)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1166884"},{"issue":"3","key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.ajog.2017.11.561","article-title":"Aspirin for the prevention of preterm and term preeclampsia: systematic review and meta\u2010analysis","volume":"218","author":"Roberge S","year":"2018","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1704559"},{"issue":"5","key":"e_1_2_13_5_1","doi-asserted-by":"crossref","first-page":"585.e1","DOI":"10.1016\/j.ajog.2017.07.038","article-title":"Aspirin for evidence\u2010based preeclampsia prevention trial: effect of aspirin in prevention of preterm preeclampsia in subgroups of women according to their characteristics and medical and obstetrical history","volume":"217","author":"Poon LC","year":"2017","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002708"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2023.04.039"},{"key":"e_1_2_13_8_1","volume-title":"Hypertension in pregnancy: diagnosis and management. 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