{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:44:40Z","timestamp":1791499480767,"version":"4.3.4"},"reference-count":63,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","license":[{"start":{"date-parts":[[2024,10,15]],"date-time":"2024-10-15T00:00:00Z","timestamp":1728950400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"start-up grant from Faculty of Medicine, the Chinese University of Hong Kong"},{"DOI":"10.13039\/100011033","name":"Thermo Fisher Scientific","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100011033","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Revvity"},{"name":"Roche Holding | Roche Diagnostics"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2024,10,15]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>This trial aimed to assess the efficacy, acceptability, and safety of a first-trimester screen-and-prevent strategy for preterm preeclampsia in Asia.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>Between August 1, 2019, and February 28, 2022, this multicenter stepped wedge cluster randomized trial included maternity\/diagnostic units from 10 regions in Asia. The trial started with a period where all recruiting centers provided routine antenatal care without study-related intervention. At regular 6-week intervals, one cluster was randomized to transit from nonintervention phase to intervention phase. In the intervention phase, women underwent first-trimester screening for preterm preeclampsia using a Bayes theorem-based triple-test. High-risk women, with adjusted risk for preterm preeclampsia \u22651 in 100, received low-dose aspirin from &lt;16 weeks until 36 weeks.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>Overall, 88.04% (42\u2009897 of 48\u2009725) of women agreed to undergo first-trimester screening for preterm preeclampsia. Among those identified as high-risk in the intervention phase, 82.39% (2919 of 3543) received aspirin prophylaxis. There was no significant difference in the incidence of preterm preeclampsia between the intervention and non-intervention phases (adjusted odds ratio [aOR], 1.59 [95% CI, 0.91\u20132.77]). However, among high-risk women in the intervention phase, aspirin prophylaxis was significantly associated with a 41% reduction in the incidence of preterm preeclampsia (aOR, 0.59 [95% CI, 0.37\u20130.92]). In addition, it correlated with 54%, 55%, and 64% reduction in the incidence of preeclampsia with delivery at &lt;34 weeks (aOR, 0.46 [95% CI, 0.23\u20130.93]), spontaneous preterm birth &lt;34 weeks (aOR, 0.45 [95% CI, 0.22\u20130.92]), and perinatal death (aOR, 0.34 [95% CI, 0.12\u20130.91]), respectively. There was no significant between-group difference in the incidence of aspirin-related severe adverse events.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>The implementation of the screen-and-prevent strategy for preterm preeclampsia is not associated with a significant reduction in the incidence of preterm preeclampsia. However, low-dose aspirin effectively reduces the incidence of preterm preeclampsia by 41% among high-risk women. The screen-and-prevent strategy for preterm preeclampsia is highly accepted by a diverse group of women from various ethnic backgrounds beyond the original population where the strategy was developed. These findings underpin the importance of the widespread implementation of the screen-and-prevent strategy for preterm preeclampsia on a global scale.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT03941886.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.124.069907","type":"journal-article","created":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T12:30:27Z","timestamp":1719405027000},"page":"1223-1235","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":38,"title":["Implementation of First-Trimester Screening and Prevention of Preeclampsia: A Stepped Wedge Cluster-Randomized Trial in Asia"],"prefix":"10.1161","volume":"150","clinical-trial-number":[{"clinical-trial-number":"nct03941886","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Long","family":"Nguyen-Hoang","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Prince of Wales Hospital (L.N.-H., A.S.T.T., H.H.Y.L., N.M.W.L., S.L.L., I.Y.M.W., X.L., D.S.S., L.C.P.), Chinese University of Hong Kong."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linh Thuy","family":"Dinh","sequence":"additional","affiliation":[{"name":"Center for Prenatal and Neonatal Screening and Diagnosis, Hanoi Obstetrics and Gynecology Hospital, Vietnam (L.T.D., D.-A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela S.T.","family":"Tai","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Prince of Wales Hospital (L.N.-H., A.S.T.T., H.H.Y.L., N.M.W.L., S.L.L., I.Y.M.W., X.L., D.S.S., L.C.P.), Chinese University of Hong Kong."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1362-0332","authenticated-orcid":true,"given":"Duy-Anh","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Center for Prenatal and Neonatal Screening and Diagnosis, Hanoi Obstetrics and Gynecology Hospital, Vietnam (L.T.D., D.-A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1527-4595","authenticated-orcid":true,"given":"Ritsuko K.","family":"Pooh","sequence":"additional","affiliation":[{"name":"Clinical Research Institute of Fetal Medicine Prenatal Medical Clinic, Osaka, Japan (R.K.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arihiro","family":"Shiozaki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Toyama University Hospital, Toyama, Japan 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