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This study aims to examine whether a first-trimester strategy of secondary prevention for preeclampsia increases anxiety in pregnant women.The anxiety levels of a cohort of women screened for preeclampsia at first trimester were measured by the Spielberg State–Trait Anxiety Inventory (STAI-S) and compared between women screened as low and high risk. In a subgroup of women, the anxiety levels were additionally measured at second and third trimester. A General Linear Model (GLM) for repeated measurements was performed to adjust for potential confounders (age, nulliparity and socio-economic level).A total of 255 women (135 low-risk and 120 high-risk) were evaluated. No differences were found in the mean STAI-S scores between low-risk and high-risk women: 35 (SD 9.9) and 34.6 (SD 10.1); p = 0.77. The proportion of women with high anxiety was not significantly different between groups (28/134 [20.7%] vs 24/120 [20%]; p = 0.88). No differences were found in the subgroups (51 low-risk and 50 high-risk) in which the anxiety levels were also measured at second and third trimester: 35.8 (SD 8.8) vs 35.2 (SD 9.7), p = 0.74, and 37.2 (SD 9.4) vs 35.3 (SD 8.6), p = 0.3. These differences remained non-significant after adjustment for potential confounders.A strategy of first-trimester screening for preeclampsia does not increase maternal anxiety. © 2014 John Wiley & Sons, Ltd.What's already known about this topic?The first trimester screening risk for preeclampsia results from the combination of maternal characteristics with uterine artery Doppler, blood pressure, angiogenic factors and placental-associated protein A. The potential harms and ethical concerns depend on the so-called false positives, the anxiety associated with being labeled as ‘high risk’, and the interventions provided for surveillance/prophylaxis in these cases.What does this study add?The first-trimester screening for preeclampsia does not increase maternal anxiety during pregnancy.