Adverse pregnancy outcomes are increasingly recognized as markers of future maternal cardiovascular risk, but the long-term stroke risk associated with preterm delivery (PTD), particularly spontaneous PTD, has remained uncertain. A systematic review and meta-analysis published in Stroke evaluated this association across 21 observational cohort and case-control studies involving 8.7 million parous women.

PubMed, CINAHL, and Web of Science were searched for eligible articles published between January 1, 2000, and May 6, 2025. The primary exposure was any PTD, with secondary analyses of spontaneous PTD and medically indicated PTD. The primary outcome was any stroke, with secondary outcomes of ischemic stroke and hemorrhagic stroke. Follow-up ranged from 8 to 57 years.

PTD was consistently associated with increased stroke risk. Any PTD was associated with a higher risk of any stroke (adjusted risk ratio [aRR], 1.66; 95% CI, 1.34–2.05). Spontaneous PTD (aRR, 1.37; 95% CI, 1.15–1.64) and medically indicated PTD (aRR, 2.08; 95% CI, 1.70–2.54) were also associated with any stroke. PTD was additionally associated with ischemic stroke (aRR, 1.59; 95% CI, 1.45–1.75) and hemorrhagic stroke (aRR, 1.44; 95% CI, 1.06–1.94).

A high level of heterogeneity was observed (I²=97%; τ²=0.15), possibly related to differences in exposure definitions, outcome ascertainment, and follow-up duration across studies. Women with prior PTD, including spontaneous PTD, may be at increased risk of stroke later in life and may benefit from targeted postpartum cardiometabolic preventive interventions.