Abstract P195: Reproductive History and Subsequent Stroke in Middle-aged African American Women: The Pitt County Study

Abstract

Introduction: Women with a history of pregnancy loss or delivery of low birth weight (< 2500 grams) and/or preterm (< 37 weeks gestation) (LBW/PTB) infants have an increased subsequent risk for cardiovascular morbidity and mortality. The association between nulliparity and cardiovascular disease has been mixed; some studies reported excess risk among nulliparous women compared to women who had one or two births, while others found decreased risk. Research among African American women is limited regarding whether reproductive history influences risk for cardiovascular disease (e.g., stroke). Hypothesis: We investigated whether a history of pregnancy loss, LBW/PTB delivery and nulliparity increased risk for stroke among middle-aged African American women. Methods: Multiple logistic regression was used to determine the association between LBW/PTB delivery and hypertension among 750 African American female participants (mean baseline age = 35.4 years) in the Pitt County Study, a 13 year (1988-2001) probability-based cohort study in eastern North Carolina. Reproductive history and physician-diagnosed stroke were assessed by self-report in 2001. Statistical analyses adjusted for known and suspected confounders, including adult socioeconomic position, medical conditions, health behaviors, and psychosocial risk factors. Results: By 2001, 3% of the women, ages 37 to 63 years, reported having had a stroke. 33% reported at least one pregnancy loss and 21% had a reproductive history of LBW/PTB delivery. After adjusting for confounders, women with a history of pregnancy loss had 2.9 times the odds of stroke compared to those not experiencing a pregnancy loss; covariate-adjusted AOR = 2.94; 95%CI: (1.97, 4.37). Women with a history of LBW/PTB had a 61% greater odds of stroke compared to those who had only normal weight and at-term births, AOR = 1.61; 95%CI: (1.07, 2.44). Women who never had a pregnancy or a live birth also had increased risk for stroke, AOR = 5.09; 95%CI: (3.03, 8.54) and AOR = 2.85; 95%CI: (1.75, 4.64), respectively. Conclusions: History of pregnancy loss, LBW/PTB delivery and nulliparity were independently associated with increased risk for stroke among middle-aged African American women. These findings highlight the potential of reproductive history to be a clinically useful predictive marker of later-life stroke for African American women.