Objectives. We determined whether African American women’s lifetime exposure to interpersonal racial discrimination is associated with pregnancy outcomes. Methods. We performed a case–control study among 104 African American women who delivered very low birthweight (<1500 g) preterm (<37 weeks) infants and 208 African American women who delivered non–low-birthweight (>2500g) term infants in Chicago, Ill. Results. The unadjusted and adjusted odds ratio of very low birthweight infants for maternal lifetime exposure to interpersonal racism in 3 or more domains equaled 3.2 (95% confidence intervals=1.5, 6.6) and 2.6 (1.2, 5.3), respectively. This association tended to persist across maternal sociodemographic, biomedical, and behavioral characteristics. Conclusions. The lifelong accumulated experiences of racial discrimination by African American women constitute an independent risk factor for preterm delivery.