{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:04:22Z","timestamp":1790103862045,"version":"4.0.1"},"reference-count":55,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"unspecified","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007344","name":"Achmea","doi-asserted-by":"publisher","award":["2022424"],"award-info":[{"award-number":["2022424"]}],"id":[{"id":"10.13039\/501100007344","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,27]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Hypertensive disorders of pregnancy (HDP) are associated with maternal and neonatal morbidity. Although delivery is the definitive treatment, antihypertensive agents are often prescribed to control blood pressure to facilitate safe prolongation of pregnancy. International guidelines vary in their treatment recommendations and preferences for methyldopa, labetalol and nifedipine. Within the field of HDP, randomised trials are often underpowered and observational studies are limited in causal inference due to confounding. Therefore, we propose a target trial emulation with hospital-based electronic health record (EHR) data to compare methyldopa, labetalol and nifedipine in pregnancies complicated by HDP, focusing on maternal and perinatal outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will emulate a target trial by using multicentre EHR data of four university and two non-university hospitals in the Netherlands covering the period from 2006 to 2025, although data availability varied across hospitals. With algorithm-based data extraction, we will collect EHR data from patients with an obstetric diagnosis-treatment code and a prescription of methyldopa, labetalol or nifedipine during pregnancy. Time zero between patients will be aligned to minimise the risk of immortal time bias. Therefore, patients will be stratified into gestational age groups at treatment initiation. Primary outcomes include severe hypertension and severe small for gestational age (SGA) below the third percentile. Secondary maternal outcomes include the development of pre-eclampsia, haemolysis, elevated liver enzymes and low platelets syndrome, acute kidney injury, maternal intensive care unit (ICU) admission, mortality and mode of delivery. Secondary perinatal outcomes include birth weight, SGA below the 10th percentile, fetal growth restriction (diagnosed based on ultrasound data), gestational age, preterm birth &lt;37\u2009and &lt;34 weeks, Apgar score, neonatal ICU admission, neonatal hypoglycaemia and perinatal mortality. Weighted multivariable mixed-effects logistic or linear regression models will be used, depending on the outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The Medical Research Ethics Committee of the University Medical Centre Utrecht (NedMec, 23-092\/DB) confirmed that formal ethical approval was not required. Study findings will be disseminated through publication in peer-reviewed scientific journals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-121623","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:35:25Z","timestamp":1790102125000},"page":"e121623","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Oral antihypertensive agents in hypertensive pregnancies and adverse maternal and perinatal outcomes: study protocol for a target trial emulation using Dutch electronic health record data"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7023-0274","authenticated-orcid":false,"given":"Rosalie J","family":"Hup","sequence":"first","affiliation":[{"name":"Department of Obstetrics, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin W M","family":"Vernooij","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands"},{"name":"Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands"},{"name":"Central Diagnostic Laboratory, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7243-2115","authenticated-orcid":false,"given":"Wessel","family":"Ganzevoort","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca C","family":"Painter","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Kooiman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Erasmus MC Universitair Medisch Centrum Rotterdam, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven V","family":"Koenen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber A","family":"Vos","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, St Antonius Ziekenhuis, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanne","family":"Gordijn","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wes","family":"Onland","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands"},{"name":"Amsterdam Reproduction and Development, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floris","family":"Groenendaal","sequence":"additional","affiliation":[{"name":"Department of Neonatology, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9044-7022","authenticated-orcid":false,"given":"Jannick A N","family":"Dorresteijn","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saskia","family":"Haitjema","sequence":"additional","affiliation":[{"name":"Central Diagnostic Laboratory, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martine","family":"Depmann","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A Titia","family":"Lely","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"2026092211351666000_16.9.e121623.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.preghy.2018.05.004"},{"key":"2026092211351666000_16.9.e121623.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.preghy.2021.09.008"},{"key":"2026092211351666000_16.9.e121623.3","doi-asserted-by":"crossref","DOI":"10.1177\/2050312119843700","article-title":"Hypertension in pregnancy: Pathophysiology and treatment","volume":"7","author":"Braunthal","year":"2019","journal-title":"SAGE Open Med"},{"key":"2026092211351666000_16.9.e121623.4","article-title":"Antihypertensive drug therapy for mild to moderate hypertension during pregnancy","volume":"10","author":"Abalos","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"2026092211351666000_16.9.e121623.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l2381","article-title":"Pre-eclampsia: pathophysiology and clinical implications","volume":"366","author":"Burton","year":"2019","journal-title":"BMJ"},{"key":"2026092211351666000_16.9.e121623.6","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003020"},{"key":"2026092211351666000_16.9.e121623.7","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003891"},{"key":"2026092211351666000_16.9.e121623.8","unstructured":"National Institute for Health and Care Excellence (NICE) . Hypertension in pregnancy: diagnosis and management NICE guideline NG133, updated 2023. London, 2019."},{"key":"2026092211351666000_16.9.e121623.9","unstructured":"Nederlandse Vereniging voor Obstetrie en Gynaecologie (NVOG) . Hypertensieve aandoeningen in de zwangerschap. Utrecht, 2014."},{"key":"2026092211351666000_16.9.e121623.10","doi-asserted-by":"crossref","first-page":"110196","DOI":"10.1016\/j.biopha.2020.110196","article-title":"Methyldopa as an inductor of postpartum depression and maternal blues: A review","volume":"127","author":"Wici\u0144ski","year":"2020","journal-title":"Biomed Pharmacother"},{"key":"2026092211351666000_16.9.e121623.11","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2012-001185","article-title":"\u03b2-Blocker treatment during pregnancy and adverse pregnancy outcomes: a nationwide population-based cohort study","volume":"2","author":"Meidahl Petersen","year":"2012","journal-title":"BMJ Open"},{"key":"2026092211351666000_16.9.e121623.12","unstructured":"Netherlands Pharmacovigilance Centre Lareb . Calciumblokkers tijdens de zwangerschap. Available: https:\/\/www.lareb.nl\/mvm-kennis-pagina\/Calciumblokkers+tijdens+de+zwangerschap [Accessed 6 Mar 2026]."},{"key":"2026092211351666000_16.9.e121623.13","unstructured":"Netherlands Pharmacovigilance Centre Lareb . Betablokkers tijdens de zwangerschap."},{"key":"2026092211351666000_16.9.e121623.14","unstructured":"U.S. Food and Drug Administration . Nifedipine tablet, extended release - drug label. DailyMed, National Library of Medicine (NHI); 2024. Available: https:\/\/dailymed.nlm.nih.gov\/dailymed\/lookup.cfm?setid=925e2ea9-f51a-4b89-ab5d-ce590b6c4d85 [Accessed 22 Apr 2026]."},{"key":"2026092211351666000_16.9.e121623.15","unstructured":"U.S. Food and Drug Administration . Methyldopa tablet, film-coated - drug label. DailyMed, National Library of Medicine (NHI); 2010. Available: https:\/\/dailymed.nlm.nih.gov\/dailymed\/lookup.cfm?setid=c8bea68b-3932-4538-b568-a296a8817291 [Accessed 22 Apr 2026]."},{"key":"2026092211351666000_16.9.e121623.16","unstructured":"U.S. Food and Drug Administration . Labetalol hydrochloride tablet, film-coated - drug label. DailyMed, National Library of Medicine (NHI); 2024. Available: https:\/\/dailymed.nlm.nih.gov\/dailymed\/lookup.cfm?setid=733d6e32-ac90-4796-bf25-9d5887c897a5&utm_source=chatgpt.com [Accessed 22 Apr 2026]."},{"key":"2026092211351666000_16.9.e121623.17","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.ajog.2025.04.011","article-title":"Oral antihypertensive treatment during pregnancy: a systematic review and network meta-analysis","volume":"233","author":"Hup","year":"2025","journal-title":"Am J Obstet Gynecol"},{"key":"2026092211351666000_16.9.e121623.18","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0268284","article-title":"Maternal and neonatal outcomes of antihypertensive treatment in pregnancy: A retrospective cohort study","volume":"17","author":"Dublin","year":"2022","journal-title":"PLoS One"},{"key":"2026092211351666000_16.9.e121623.19","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1161\/HYPERTENSIONAHA.122.18920","article-title":"Role of Antihypertensive Treatment and Blood Pressure Control in the Occurrence of Adverse Pregnancy Outcomes: a Population-Based Study of Linked Electronic Health Records","volume":"79","author":"Al Khalaf","year":"2022","journal-title":"Hypertension"},{"key":"2026092211351666000_16.9.e121623.20","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s40471-023-00339-7","article-title":"Emulating a Target Trial in Perinatal Pharmacoepidemiology: Challenges and Methodological Approaches","volume":"10","author":"Chiodo","year":"2023","journal-title":"Curr Epidemiol Rep"},{"key":"2026092211351666000_16.9.e121623.21","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwv254"},{"key":"2026092211351666000_16.9.e121623.22","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000001562"},{"key":"2026092211351666000_16.9.e121623.23","doi-asserted-by":"crossref","DOI":"10.1016\/j.jacadv.2025.102054","article-title":"Comparative Effectiveness and Safety of Labetalol Versus Nifedipine for Treatment of Chronic Hypertension During Pregnancy","volume":"4","author":"Leonard","year":"2025","journal-title":"JACC Adv"},{"key":"2026092211351666000_16.9.e121623.24","doi-asserted-by":"crossref","unstructured":"Latour CD , Ponder M , Boggess KA , et al . Comparative effectiveness of initiating nifedipine versus labetalol in early gestation for chronic hypertension in pregnancy. Obstet Gynecol [Preprint] 2025. doi:10.1101\/2025.08.05.25333078","DOI":"10.1101\/2025.08.05.25333078"},{"key":"2026092211351666000_16.9.e121623.25","doi-asserted-by":"crossref","unstructured":"Atkinson JA , Hiscock RJ , Forsythe A , et al . A comparison of the safety of oral labetalol versus nifedipine to manage hypertension in pregnancy: a target trial emulation. SSRN [Preprint] 2025. doi:10.2139\/ssrn.5910019","DOI":"10.2139\/ssrn.5910019"},{"key":"2026092211351666000_16.9.e121623.26","unstructured":"Nederlandse Vereniging voor Obstetrie en Gynaecologie (NVOG) . Dreigende vroeggeboorte. 2012."},{"key":"2026092211351666000_16.9.e121623.27","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.153817"},{"key":"2026092211351666000_16.9.e121623.28","unstructured":"Farmacotherapeutisch Kompas . Methyldopa. Available: https:\/\/www.farmacotherapeutischkompas.nl\/bladeren\/preparaatteksten\/m\/methyldopa [Accessed 11 Dec 2025]."},{"key":"2026092211351666000_16.9.e121623.29","doi-asserted-by":"crossref","unstructured":"Doyle LW , Crowther CA , Middleton P , et al . Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev 2009;CD004661. doi:10.1002\/14651858.CD004661.pub3","DOI":"10.1002\/14651858.CD004661.pub3"},{"key":"2026092211351666000_16.9.e121623.30","unstructured":"Nederlandse Vereniging voor Obstetrie en Gynaecologie (NVOG) . Tocolyse bij dreigende vroeggeboorte. 2025."},{"key":"2026092211351666000_16.9.e121623.31","unstructured":"Nederlandse Vereniging voor Obstetrie en Gynaecologie (NVOG) . Preventie en behandeling van early-onset neonatale infecties. 2017."},{"key":"2026092211351666000_16.9.e121623.32","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0140-6736(10)61351-7","article-title":"Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model","volume":"377","author":"von Dadelszen","year":"2011","journal-title":"The Lancet"},{"key":"2026092211351666000_16.9.e121623.33","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15884"},{"key":"2026092211351666000_16.9.e121623.34","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2393-9-8","article-title":"The HELLP syndrome: clinical issues and management. A Review","volume":"9","author":"Haram","year":"2009","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026092211351666000_16.9.e121623.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2004.06.008"},{"key":"2026092211351666000_16.9.e121623.36","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1111\/tog.12257","article-title":"Acute kidney injury in pregnancy and the use of non\u2010steroidal anti\u2010inflammatory drugs","volume":"18","author":"Wiles","year":"2016","journal-title":"Obstet Gynaecol"},{"key":"2026092211351666000_16.9.e121623.37","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1161\/HYPERTENSIONAHA.119.13089","article-title":"Pregnancy-Related Acute Kidney Injury in Preeclampsia","volume":"74","author":"Conti-Ramsden","year":"2019","journal-title":"Hypertension"},{"key":"2026092211351666000_16.9.e121623.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2018.11.599"},{"key":"2026092211351666000_16.9.e121623.39","unstructured":"Nederlandse Vereniging voor Kindergeneeskunde (NVK); Koninklijke Nederlandse Organisatie van Verloskundigen (KNOV); Nederlandse Vereniging voor Obstetrie en Gynaecologie (NVOG) . Definitie van neonatale hypoglycemie. 2021."},{"key":"2026092211351666000_16.9.e121623.40","unstructured":"World Health Organization . WHO libr; neonatal and perinatal mortality: country, regional and global estimates. 2006."},{"key":"2026092211351666000_16.9.e121623.41","unstructured":"Statistics Netherlands (CBS) . Socio-economic status by four-digit postal code (SES-WOA). The Hague\/Heerlen, Statistics Netherlands; 2024. Available: https:\/\/www.cbs.nl\/nl-nl\/maatwerk\/2024\/24\/sociaal-economische-status-per-viercijferige-postcode [Accessed 27 Jul 2026]."},{"key":"2026092211351666000_16.9.e121623.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.09.076"},{"key":"2026092211351666000_16.9.e121623.43","doi-asserted-by":"publisher","DOI":"10.1097\/aog.0000000000002960"},{"key":"2026092211351666000_16.9.e121623.44","doi-asserted-by":"crossref","first-page":"2221","DOI":"10.1253\/circj.CJ-15-0617","article-title":"Beta-Blockers and Fetal Growth Restriction in Pregnant Women With Cardiovascular Disease","volume":"80","author":"Tanaka","year":"2016","journal-title":"Circ J"},{"key":"2026092211351666000_16.9.e121623.45","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.07911109"},{"key":"2026092211351666000_16.9.e121623.46","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1016\/S0140-6736(10)60709-X","article-title":"Antiphospholipid syndrome","volume":"376","author":"Ruiz-Irastorza","year":"2010","journal-title":"The Lancet"},{"key":"2026092211351666000_16.9.e121623.47","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.00240110"},{"key":"2026092211351666000_16.9.e121623.48","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1161\/HYPERTENSIONAHA.121.18415","article-title":"Oral Antihypertensives for Nonsevere Pregnancy Hypertension: Systematic Review, Network Meta- and Trial Sequential Analyses","volume":"79","author":"Bone","year":"2022","journal-title":"Hypertension"},{"key":"2026092211351666000_16.9.e121623.49","unstructured":"General Data Protection Regulation (GDPR) . 2018. Available: https:\/\/gdpr-info.eu\/ [Accessed 26 Nov 2025]."},{"key":"2026092211351666000_16.9.e121623.50","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1002\/phar.2778","article-title":"Maternal and neonatal outcomes associated with treating hypertension in pregnancy at different thresholds","volume":"43","author":"Avalos","year":"2023","journal-title":"Pharmacotherapy"},{"key":"2026092211351666000_16.9.e121623.51","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1111\/jch.13397","article-title":"Beta\u2010blocker subtypes and risk of low birth weight in newborns","volume":"20","author":"Duan","year":"2018","journal-title":"J Clin Hypertension"},{"key":"2026092211351666000_16.9.e121623.52","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.10.878"},{"key":"2026092211351666000_16.9.e121623.53","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1111\/1471-0528.13569","article-title":"Do labetalol and methyldopa have different effects on pregnancy outcome? Analysis of data from the Control of Hypertension In Pregnancy Study (CHIPS) trial","volume":"123","author":"Magee","year":"2016","journal-title":"BJOG"},{"key":"2026092211351666000_16.9.e121623.54","doi-asserted-by":"crossref","first-page":"101295","DOI":"10.1016\/j.preghy.2025.101295","article-title":"Oral antihypertensive agents in hypertensive pregnancy and adverse perinatal outcomes: a Dutch population-based cohort study","volume":"43","author":"Hup","year":"2026","journal-title":"Pregnancy Hypertens"},{"key":"2026092211351666000_16.9.e121623.55","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1111\/ppe.70079","article-title":"Safety of Antihypertensive Medication for the Management of Non-Severe Gestational Hypertension Among Pregnant Individuals in Botswana-Emulating a Series of Target Trials","volume":"40","author":"DiTosto","year":"2026","journal-title":"Paediatr Perinat Epidemiol"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-121623","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:35:33Z","timestamp":1790102133000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-121623"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":55,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,22]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bmjopen-2026-121623"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-121623","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}