Stroke during pregnancy or shortly after delivery, while rare, represents a serious threat to maternal and fetal health, according to a new scientific statement from the American Heart Association endorsed by the American College of Obstetricians & Gynecologists. The statement, published in the journal Stroke, emphasizes that increased awareness and coordinated care for stroke risk factors, diagnosis, treatment, and recovery are crucial. Stroke occurs in approximately 20 to 40 of every 100,000 pregnancies and accounts for an estimated 4-6% of pregnancy-related deaths annually in the U.S., highlighting the critical need for focused attention on this issue.
"When a stroke occurs during pregnancy or the postpartum period, it can lead to serious complications for both the mother and baby, including neurological deficits, long-term disability, increased risk of future strokes and death," said Dr. Eliza Miller, chair of the writing group. The physiological changes of pregnancy, including vascular and hormonal shifts, can contribute to stroke risk. Other significant risk factors include chronic hypertension, hypertensive disorders of pregnancy like preeclampsia, advanced maternal age, diabetes, obesity, and migraine with aura. Notably, stroke disproportionately affects racial and ethnic minorities; a 2020 meta-analysis found pregnant Black women are twice as likely to have a stroke compared to pregnant white women, even after adjusting for socioeconomic factors.
The statement authors stress that primary prevention should ideally begin before conception. Women considering pregnancy are encouraged to follow strategies in the 2024 American Heart Association/American Stroke Association Guideline for the Primary Prevention of Stroke and adopt healthy lifestyle behaviors outlined in Life’s Essential 8. The majority of maternal strokes are preventable with earlier, more aggressive blood pressure control. The Association’s 2025 High Blood Pressure Guideline uses diagnostic criteria for hypertension in pregnancy. "Preeclampsia and eclampsia can occur before, during or after delivery, and the early postpartum period is actually the highest risk time for stroke. Very close monitoring of blood pressure is essential," Miller noted. Treating high blood pressure during pregnancy and postpartum with medication and the use of daily low-dose aspirin for high-risk individuals can help prevent complications.
For diagnosis and treatment, the statement urges all healthcare professionals caring for pregnant patients to be trained to recognize stroke symptoms for prompt intervention. Imaging techniques for diagnosis are safe for pregnant patients, and pregnancy should not delay recommended acute stroke treatment, including anti-clotting medications and mechanical thrombectomy. Regarding delivery, stroke during pregnancy is not an automatic indication for immediate delivery if the mother is stable and the fetus is preterm, though it may become necessary if the mother's condition worsens.
Recovery presents unique challenges, as survivors must often care for an infant while managing post-stroke conditions like fatigue, anxiety, and depression, which may be intensified by postpartum factors. Support from a multidisciplinary rehabilitation team and engagement of family and caregivers are essential. "Babies depend on their mothers' well-being, and supporting recovery after stroke, both emotionally and practically, is essential so mothers can heal and families can thrive," Miller said. The statement calls for more research, including clinical trials, to refine risk assessment and expand treatment options, as pregnant and postpartum women have historically been excluded from such trials, limiting evidence-based care.
