Preterm birth (PTB) has known differential risk by race. However, the interplay between race, stress, education and PTB is poorly described. We sought to investigate the impact of race and stress on PTB in highly educated women at risk for preterm birth. We conducted a secondary analysis of a multicenter, randomized trial of progesterone for recurrent preterm birth prevention. We included women with non-anomalous, singleton gestations with >12 years of education. We excluded women with cerclage. Our primary exposure was self-reported race. Our primary outcome was delivery at < 37, 35, and 32 weeks. Maternal stress was defined by ratio of progesterone (P) to salivary estradiol (E3), with a low P/E3 reflecting high stress. In the subset of women with P/E3, stress was assessed as an effect modifier to PTB. We conducted ANOVA and chi-squared to analyze baseline characteristics and fit a logistic regression model adjusting for confounders. We assessed P/E3 levels by race and added this to our final model. Of 129 included women with >12 years of education, 51 (39.5%) were African American, 58 (45.0%) Caucasian, 15 (11.6%) Hispanic, and 4 (3.1%) were classified as Other. The groups differed by maternal age, marital status, and pre-delivery infection but were similar in other baseline characteristics. In both bivariable and multivariable analyses, race was not associated with an increased risk of PTB < 37 or < 35 weeks (Table). Differences were appreciated at < 32 weeks, but this finding was not statistically significant likely due to the small numbers of PTB< 32 weeks. Stress levels were not significantly different by race (Figure). Adjusting for maternal stress did not change our outcomes. Among highly educated women at high risk for preterm birth, race disparities in recurrent preterm birth were not appreciated.View Large Image Figure ViewerDownload Hi-res image Download (PPT)