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Association of Prepregnancy Cardiovascular Risk Factors Clusters With Stillbirth Risk Across Racial and Ethnic

Jing Nie1,2,3, Leandro F M Rezende4,5, Gerson Ferrari5,6

  • 1Population Research Institute, Nanjing University of Posts and Telecommunications Nanjing Jiangsu China.

Journal of the American Heart Association
|July 29, 2025
PubMed

Insights

Prepregnancy cardiovascular risk factors like diabetes and hypertension significantly increase stillbirth risk. Non-Hispanic Black mothers face disproportionately higher risks, highlighting the need for targeted interventions.

Area of Science:

  • Cardiovascular health
  • Reproductive health
  • Public health disparities

Background:

  • The link between prepregnancy cardiovascular risk factors and stillbirth is not fully understood, especially across different racial and ethnic groups.
  • Cardiovascular risk factors include diabetes, hypertension, smoking, and nonideal body mass index.

Purpose of the Study:

  • To evaluate the association between 16 distinct cardiovascular risk clusters and stillbirth.
  • To emphasize racial disparities in stillbirth risk related to cardiovascular factors.

Main Methods:

  • A nationwide, population-based study analyzed Centers for Disease Control and Prevention data from 2014-2022.
  • Included over 31 million singleton births and 131,000 stillbirths (≥20 weeks' gestation).
  • Used modified Poisson regression to assess risks associated with 16 cardiovascular risk factor clusters.

Main Results:

  • Prepregnancy diabetes posed the highest stillbirth risk (aRR, 4.05), followed by hypertension (aRR, 2.44), smoking (aRR, 1.62), and unhealthy BMI (aRR, 1.33).
  • Biological interactions between risk factors, particularly involving diabetes, showed excess risk.
  • Non-Hispanic Black mothers had nearly double the relative and absolute stillbirth risks compared to non-Hispanic White mothers.

Conclusions:

  • Prepregnancy cardiovascular risk profiles are strongly linked to stillbirth, with significant racial and ethnic disparities.
  • Simplified risk scoring may overlook crucial risk variations.
  • Race-conscious, targeted interventions are essential to address these disparities.
Abstract

Keywords:
cardiovascular healthepidemiologypregnancyrisk factorstillbirth

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