Pregnancy puts stroke survivors at increased risk of recurrence

Having had a stroke caused by blocked blood vessels (ischemic stroke) more than doubled an expectant mother’s odds of having another stroke during pregnancy and within six weeks of childbirth, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2026 in New Orleans, Feb. 4-6, 2026. 

Adnan I. Qureshi, M.D.

© Zeenat Qureshi Stroke Institutes 

“A common question for women is whether to risk pregnancy after a previous ischemic stroke. Our analysis found that women are at a greater risk of recurrent ischemic stroke during pregnancy and in the six weeks after giving birth, and the increased risk is not influenced by other risk factors,” said study lead author Adnan I. Qureshi, M.D., a professor of neurology at the University of Missouri in Columbia, Missouri, and founder of Zeenat Qureshi Stroke Institutes. “Now, women and their health care professionals can make a more informed decision about the risks related to pregnancy. Women who have experienced a stroke and become pregnant need additional attention to ensure they get the highest level of care to reduce their risk of another stroke.” 

Using electronic health records from hospitals across the U.S., researchers analyzed the risk of new ischemic stroke in women ages 15 to 50 with and without a history of previous stroke who had recently delivered a baby (considered the early postpartum period). They compared the rates of strokes from 2015 to 2025 in women who had a recurrent stroke in pregnancy or soon after childbirth with the other women who had a first-time stroke during the same period. 

The analysis found: 

• The stroke rate was higher in pregnant women who had a prior stroke compared to those who had been stroke-free: 415 new ischemic strokes among 1,192 pregnant women who had a previous stroke (34.82%) compared to 737 new strokes among 219,287 (0.34%) pregnant women without a history of ischemic stroke. 
• Among 1,192 pregnant women with a history of stroke, 415 new strokes occurred during pregnancy and soon after childbirth. 
• Out of 219,287 pregnant women without a prior stroke, 737 new strokes occurred during the same period. 
• After adjusting for demographic and health factors, such as race, other medical conditions and medications, women who had a history of prior stroke were more than twice as likely to have a second stroke during pregnancy and in the early postpartum period compared with those who had no previous stroke. 
• The risk of ischemic stroke during pregnancy and the early postpartum period was 82% more likely among pregnant women who had a previous heart attack and 25% more likely in women with obesity.

© American Heart Association

According to Jennifer Lewey, M.D., M.P.H., chair of the writing committee of the 2024 American Heart Association Scientific Statement: Opportunities in the Postpartum Period to Reduce Cardiovascular Disease Risk After Adverse Pregnancy Outcomes, “Stroke during pregnancy or the early postpartum period can have devastating long-term consequences for the mother and her family. The results of this study give us an opportunity to think about how to prevent maternal stroke among those at highest risk. Women with prior ischemic stroke should receive pre-conception counseling to discuss stroke risk during pregnancy and risk reduction. Furthermore, an interdisciplinary team of neurologists and obstetricians can develop a surveillance and treatment plan during pregnancy and the postpartum period.” Lewey is also director of the Penn Women’s Cardiovascular Health Program and an assistant professor of medicine at the University of Pennsylvania Perelman School of Medicine in Philadelphia and was not involved in this study. 

Study authors say that the risk of having another stroke during pregnancy and soon after childbirth means preventive efforts should be intensified for women with a history of ischemic stroke. Future research will need to explore how specifically to lower the risk of a second stroke in this group of women. Identifying the cause of the first stroke, reviewing medications during pregnancy, managing blood pressure, eating a healthy diet and regular physical activity are proven strategies to reduce the risk of additional strokes. 

“Attention should be brought to the fact that this is a very high-risk pregnancy. Women who are pregnant and with a history of stroke should be managed at health care centers that have experience with high-risk pregnancies. There are no clinical guidelines for the management of these high-risk pregnancies. Hopefully, this study will promote the identification and categorization of these women in the high-risk pregnancy group so they can get a higher level of care from the beginning,” Qureshi said. 

The study is an observational analysis that relies on data from a large database of electronic health records, which is a limitation of the findings. 

Study details, background and design: 

• The analysis included 220,479 pregnant women (ages 15 to 50 years old) with and without a previous ischemic stroke. 
• Participants were 60.74% white women, 21.81% Black women, 1.34% Asian women, .17% Native American women and 15.94% other race. 
• Researchers used the Oracle Health Real-World Data, a large U.S. national database of electronic health records, to analyze the rate of ischemic stroke in pregnant women between 2015 and 2025. They compared the rate of second stroke during pregnancy and in the postpartum period with the rate of first-time stroke during the same period.

Source: American Heart Association 

29.01.2026

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