Sheehy Shanshan, Aparicio Hugo J, Delp Lauren, Lioutas Vasileios-Arsenios, Shulman Julie, Xu Nuo N, Rosenberg Lynn
University of Massachusetts Boston Campus.
Slone Epidemiology Center, Boston University, MA.
Neurology. 2025 Oct;105(7):e214102. doi: 10.1212/WNL.0000000000214102. Epub 2025 Sep 12.
Black women experience a higher burden of preterm delivery and stroke compared with other American women. In a recent meta-analysis, history of preterm delivery was associated with an increased risk of stroke. However, previous studies were largely based on White women. This association has not been studied among Black women.
We conducted a prospective cohort study consisting of self-identified Black women across the United States. Participants were parous women, free of cardiovascular disease, and enrolled in the Black Women's Health Study (BWHS). Exposure was a self-reported history of preterm delivery. Outcome was all incident stroke cases, including self-reported stroke identified from questionnaires, stroke adjudicated through medical records, and fatal stroke identified using the National Death Index. Cox proportional hazard models were used, adjusting for maternal reproductive factors and risk factors of stroke.
During a median of 20 years of follow-up among 41,788 parous Black women (mean age 40.5 years [SD 10.7]), 6,891 women reported a history of preterm delivery and 1,554 had incident stroke. Compared with women with no history of preterm delivery, Black women with a history of preterm delivery had a 1.30-fold increased stroke incidence (age-adjusted hazard ratio 1.30, 95% CI 1.14-1.47). The elevated stroke risk persisted after adjusting for history of hypertensive disorder during pregnancy and among the subset of stroke cases that were adjudicated through medical records reviewed by neurologists.
In this prospective study of Black women, preterm delivery was associated with a 23% higher risk of long-term stroke. This study was limited by lack of detailed information on each pregnancy over the life course of Black women. Most of the BWHS participants were already parous at the time of enrollment in 1995. Information on the reasons for preterm delivery, timing and number of preterm deliveries, and prepregnancy risk factors is lacking. Our validation study on stroke was conducted among a small and nonrandom sample of participants who provided medical records. The negative predictive value of self-reported stroke was not assessed. The higher rate of preterm delivery likely contributes to the higher burden of stroke among Black women.
与其他美国女性相比，黑人女性经历早产和中风的负担更高。在最近的一项荟萃分析中，早产史与中风风险增加有关。然而，以前的研究主要基于白人女性。这种关联在黑人女性中尚未得到研究。
我们进行了一项前瞻性队列研究，研究对象为全美自我认定的黑人女性。参与者为经产妇，无心血管疾病，参加了黑人女性健康研究（BWHS）。暴露因素是自我报告的早产史。结局是所有中风病例，包括通过问卷调查确定的自我报告中风、通过病历判定的中风以及使用国家死亡指数确定的致命中风。使用Cox比例风险模型，对孕产妇生殖因素和中风风险因素进行了调整。
在41788名经产黑人女性（平均年龄40.5岁[标准差10.7]）中位随访20年期间，6891名女性报告有早产史，1554名发生中风。与无早产史的女性相比，有早产史的黑人女性中风发病率增加了1.30倍（年龄调整后的风险比为1.30，95%可信区间为1.14-1.47）。在调整了孕期高血压疾病史后，以及在由神经科医生审查病历判定的中风病例子集中，中风风险升高仍然存在。
在这项针对黑人女性的前瞻性研究中，早产与长期中风风险高23%有关。本研究的局限性在于缺乏黑人女性一生中每次怀孕的详细信息。大多数BWHS参与者在1995年入组时已经是经产妇。缺乏早产原因、早产时间和次数以及孕前风险因素的信息。我们对中风的验证研究是在提供病历的一小部分非随机参与者中进行的。未评估自我报告中风的阴性预测值。较高的早产率可能导致黑人女性中风负担更高。
