{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T03:16:10Z","timestamp":1782962170408,"version":"3.54.5"},"reference-count":36,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T00:00:00Z","timestamp":1680739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fetal Medicine Foundation","award":["1037116"],"award-info":[{"award-number":["1037116"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Objective: This study aims to extend the understanding of the psychological impact of the first-trimester pre-eclampsia (PE) screening on women identified as high risk for preterm PE. We examined the differences between low- vs. high-risk women throughout pregnancy in: symptoms of distress (anxiety, depression, physical and mental health, and worry), health behaviour changes, the experience of pregnancy, and attitudes towards PE screening. Methods: This study was nested within the ASPRE trial. Pregnant women were screened for preterm-PE risk status in the first trimester; the assessments were carried out before the screening, in the second and in the third trimester (n = 155 low-risk women and N = 82 high-risk women in the second trimester). Results: The high-risk-for-PE women exhibited more depressive symptoms compared to the low-risk women in the second but not in the third trimester. No differences were observed between the two groups in other distress symptoms or in the women\u2019s evaluation of their experience of pregnancy. The high-risk group reported greater health behaviour changes compared to the low-risk group, but this was moderated by depression levels. Conclusions: Overall, pregnant women reported positive attitudes towards first-trimester PE screening, despite transient depressive symptoms. This study offers supportive evidence concerning the appropriateness of PE screening in ethical terms.<\/jats:p>","DOI":"10.3390\/ijerph20075418","type":"journal-article","created":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T03:59:55Z","timestamp":1680753595000},"page":"5418","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Psychological Impact and Women\u2019s Evaluation of the First-Trimester Pre-Eclampsia Screening and Prevention: ASPRE Trial"],"prefix":"10.3390","volume":"20","author":[{"given":"Ana V.","family":"Nik\u010devi\u0107","sequence":"first","affiliation":[{"name":"Department of Psychology, Kingston University, London KT1 2EE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2520-577X","authenticated-orcid":false,"given":"Chiara","family":"Sacchi","sequence":"additional","affiliation":[{"name":"Department of Developmental and Social Psychology, University of Padova, 35121 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1127-3907","authenticated-orcid":false,"given":"Claudia","family":"Marino","sequence":"additional","affiliation":[{"name":"Department of Developmental and Social Psychology, University of Padova, 35121 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"O\u2019Gorman","sequence":"additional","affiliation":[{"name":"Coombe Women and Infants University Hospital, D08 XW7X Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3944-4130","authenticated-orcid":false,"given":"Liona C.","family":"Poon","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kypros H.","family":"Nicolaides","sequence":"additional","affiliation":[{"name":"Harris Birthright Research Centre of Fetal Medicine, King\u2019s College Hospital, London SE5 8BB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,6]]},"reference":[{"key":"ref_1","first-page":"291","article-title":"The hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice","volume":"13","author":"Brown","year":"2018","journal-title":"Hypertension"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/S0002-9378(98)70439-9","article-title":"The preterm prediction study: Risk factors for indicated preterm births. Maternal-Fetal Medicine Units Network of the National Institute of Child Health and Human Development","volume":"178","author":"Meis","year":"1998","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1097\/FM9.0000000000000097","article-title":"Short term prediction of preeclampsia","volume":"3","author":"Sroka","year":"2021","journal-title":"Matern. Fetal Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1101\/cshperspect.a023473","article-title":"Molecular mechnisms of preeclampsia","volume":"5","author":"Hod","year":"2015","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1056\/NEJMoa031884","article-title":"Circulating angiogenic factors and the risk of preeclampsia","volume":"350","author":"Levine","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.trsl.2018.12.004","article-title":"Increased circulating levels of Epodermal Growth Factor-like Domain 7 in pregnant women affected by preeclampsia","volume":"207","author":"Massimiani","year":"2019","journal-title":"Transl. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"103.e1","DOI":"10.1016\/j.ajog.2015.08.034","article-title":"Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11\u201313 weeks\u2019 gestation","volume":"214","author":"Wright","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1002\/uog.17399","article-title":"Accuracy of competing-risks model in screening for pre-eclampsia by maternal factors and biomarkers at 11\u201313 weeks\u2019 gestation","volume":"49","author":"Wright","year":"2017","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1097\/AOG.0b013e3181e9322a","article-title":"Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: A meta-analysis","volume":"116","author":"Bujold","year":"2010","journal-title":"Obstet. Gynecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1056\/NEJMoa1704559","article-title":"Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia","volume":"377","author":"Rolnik","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/FM9.0000000000000005","article-title":"Screening and prevention of preeclampsia","volume":"1","author":"Poon","year":"2019","journal-title":"Matern. Fetal Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1055\/a-1534-2599","article-title":"Integrating combined first trimester screening for preeclampsia into routine ultrasound examination","volume":"82","author":"Trottmann","year":"2022","journal-title":"Geburtshilfe Frauenheilkd."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Crombag, N.M., Lamain-de Ruiter, M., Kwee, A., Schielen, P.C., Bensing, J.M., Visser, G.H., Franx, A., and Koster, M.P. (2017). Perspectives, preferences and needs regarding early prediction of preeclampsia in Dutch pregnant women: A qualitative study. BMC Preg. Childbirth, 17.","DOI":"10.1186\/s12884-016-1195-2"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s12978-019-0707-8","article-title":"Views and preferences of medical professionals and pregnant women about a novel primary prevention intervention for hypertensive disorders of pregnancy: A qualitative study","volume":"16","author":"Vestering","year":"2019","journal-title":"Reprod. Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1111\/j.1467-8519.2012.02005.x","article-title":"Ethical issues related to screening for preeclampsia","volume":"28","author":"Hedley","year":"2014","journal-title":"Bioethics"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1002\/pd.4485","article-title":"Psychological impact of first-trimester prevention for preeclampsia on anxiety","volume":"35","author":"Simeone","year":"2015","journal-title":"Prenat. Diagn."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1016\/j.midw.2014.04.006","article-title":"The psychological impact of providing women with risk information for pre-eclampsia: A qualitative study","volume":"30","author":"Harris","year":"2014","journal-title":"Midwifery"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.midw.2017.01.014","article-title":"Women\u2019s dietary changes before and during pregnancy: A systematic review","volume":"49","author":"Hillier","year":"2017","journal-title":"Midwifery"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/02646838.2018.1408965","article-title":"Health behaviour and pregnancy: A time for change","volume":"36","author":"Olander","year":"2018","journal-title":"J. Reprod. Infant Psychol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1080\/01443615.2021.1910634","article-title":"Health promotion and health-harming behaviours in pregnant women: Role of coping strategies, anxiety and depression","volume":"42","author":"Pasha","year":"2022","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1080\/02646838.2012.710834","article-title":"Assessing the psychological effects of prenatal screening tests for maternal and foetal conditions: A systematic review","volume":"30","author":"Harris","year":"2012","journal-title":"J. Reprod. Infant Psychol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1002\/pd.5554","article-title":"Reasons for accepting or declining participation in the ASPRE trial: A qualitative study with women at high-risk of preterm pre-eclampsia","volume":"39","author":"Dodd","year":"2019","journal-title":"Prenat. Diagn."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1111\/j.2044-8260.1992.tb00997.x","article-title":"The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI)","volume":"31","author":"Marteau","year":"1992","journal-title":"Br. J. Clin. Psychol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Spielberger, C.D., Gorsuch, R.L., Lushene, R.E., and Vagg, P.R. (1983). Manual for the State-Trait Anxiety Inventory, Consulting Psychologists Press.","DOI":"10.1037\/t06496-000"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1891\/1061-3749.17.1.19","article-title":"Support for the reliability and validity of a six-item state anxiety scale derived from the State-Trait Anxiety Inventory","volume":"17","author":"Tluczek","year":"2009","journal-title":"J. Nurs. Meas."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1192\/bjp.150.6.782","article-title":"Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale","volume":"150","author":"Cox","year":"1987","journal-title":"Br. J. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1177\/13591053030086008","article-title":"Factor structure, validity and reliability of the Cambridge Worry Scale in a pregnancy population","volume":"8","author":"Green","year":"2003","journal-title":"J. Health Psychol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/00005650-199603000-00003","article-title":"A 12-Item short-form health survey: Construction of scales and preliminary tests of reliability and validity","volume":"34","author":"Ware","year":"1996","journal-title":"Med. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1016\/j.socscimed.2008.06.039","article-title":"Illness representations and coping following an abnormal colorectal cancer screening result","volume":"67","author":"Orbell","year":"2008","journal-title":"Soc. Sci. Med."},{"key":"ref_30","unstructured":"R Core Team (2013). R: A Language and Environment for Statistical Computing [Computer Software Manual], R Core Team. Available online: http:\/\/www.R-project.org\/."},{"key":"ref_31","unstructured":"Rachman, S. (1980). Medical Psychology, Pergamon Press."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1037\/0278-6133.4.2.115","article-title":"Common-sense models of illness: The example of hypertension","volume":"4","author":"Meyer","year":"1985","journal-title":"Health Psychol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"506","DOI":"10.2337\/diacare.16.2.506","article-title":"Patients\u2019 attitudes toward screening for gestational diabetes mellitus in the Illawarra area, Australia","volume":"16","author":"Griffiths","year":"1993","journal-title":"Diabetes Care"},{"key":"ref_34","first-page":"634","article-title":"Does foetal screening affect women\u2019s worries about the health of their baby? A randomized controlled trial of ultrasound screening for Down\u2019s syndrome versus routine ultrasound screening","volume":"83","author":"Saltvedt","year":"2004","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_35","first-page":"292","article-title":"New concepts in screening","volume":"54","author":"Gray","year":"2004","journal-title":"Br. J. Gen. Pract."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1177\/070674370404901103","article-title":"Perinatal risks of untreated depression in pregnancy","volume":"49","author":"Bonari","year":"2004","journal-title":"Can. J. Psychiatry"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/7\/5418\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:10:58Z","timestamp":1760123458000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/7\/5418"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,6]]},"references-count":36,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["ijerph20075418"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20075418","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,6]]}}}