Preterm Delivery History Linked to Elevated Stroke Risk in Black Women

A history of preterm delivery is associated with a significantly higher long-term risk for stroke among Black women, according to study results published in Neurology.

Researchers examined whether preterm delivery, known to affect future cardiovascular health, was linked to stroke incidence in Black women. This group was specifically investigated due to their higher rates of preterm delivery and elevated stroke burden compared with women of other racial and ethnic groups.

The prospective cohort study used data from the Black Women’s Health Study, which began enrollment in 1995. Women who had given birth at least once and had no cardiovascular disease at baseline were monitored until onset of incident stroke, loss to follow-up, death, or until December 2021. Stroke outcomes were identified through questionnaires, adjudicated medical records, and linkage with the National Death Index.

Our findings indicate the importance of considering reproductive factors as female-specific stroke risk factors and potentially incorporating history of preterm delivery into stroke risk prediction for Black women.

A total of 41,788 women were included in the analysis, of whom 6891 reported a history of preterm delivery. Median age at enrollment was 38 (IQR, 21-69) years. Baseline characteristics between women with and without preterm delivery, including age at first birth and body mass index (BMI) at age 18 years, were similar. Hypertension was reported in 19% of women with preterm delivery and 16% of those without, while type 2 diabetes was present in 5% and 4%, respectively.

During follow-up, 1554 women experienced incident stroke. Women with a history of preterm delivery had a 30% higher incidence of stroke in age-adjusted models (hazard ratio [HR], 1.30; 95% CI, 1.14-1.47). After adjusting for education, parity, BMI at age 18 years, family history of stroke, socioeconomic status, and hypertensive disorders during pregnancy, the association between preterm delivery and stroke remained significant (HR, 1.23; 95% CI, 1.08-1.39).

Results were similar when restricted to neurologist-confirmed stroke cases (HR, 1.37; 95% CI, 1.11-1.70). Sensitivity analyses further adjusting for perceived racism yielded consistent findings (HR, 1.26; 95% CI, 1.10-1.44).

Study limitations include incomplete pregnancy histories and partial medical record validation for stroke.

“Our findings indicate the importance of considering reproductive factors as female-specific stroke risk factors and potentially incorporating history of preterm delivery into stroke risk prediction for Black women,” the study authors concluded.

Disclosures: This research was supported by the National Institute of Health. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.