Women who have experienced an ischemic stroke face more than double the risk of having another stroke during pregnancy and in the six weeks after giving birth compared to women without such a history, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2026. The findings, based on an analysis of a large national database of electronic health records, provide crucial data for women and healthcare providers making decisions about pregnancy after stroke.
The study analyzed electronic health records from U.S. hospitals between 2015 and 2025, examining 220,479 pregnant women aged 15 to 50. Researchers found that among 1,192 pregnant women with a history of stroke, 415 experienced a new ischemic stroke during pregnancy or the early postpartum period, representing 34.82% of this group. In contrast, among 219,287 pregnant women without a prior stroke, only 737 new strokes occurred during the same timeframe, representing just 0.34%.
After adjusting for demographic and health factors, women with a history of prior stroke were more than twice as likely to have a second stroke during pregnancy and the early postpartum period compared to those with no previous stroke. The analysis also revealed that pregnant women who had experienced a previous heart attack faced an 82% increased risk of ischemic stroke during this period, while women with obesity faced a 25% increased risk.
"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. Researchers used the Oracle Health Real-World Data, a large U.S. national database of electronic health records, available at https://www.oracle.com/health/, for their analysis.
The implications of these findings are significant for maternal healthcare. According to Jennifer Lewey, M.D., M.P.H., chair of the writing committee of the 2024 American Heart Association Scientific Statement on postpartum cardiovascular risk, "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." Lewey, who directs the Penn Women's Cardiovascular Health Program, emphasized that women with prior ischemic stroke should receive pre-conception counseling and be managed by interdisciplinary teams.
Study authors recommend that preventive efforts should be intensified for women with a history of ischemic stroke who become pregnant. They suggest that identifying the cause of the first stroke, reviewing medications during pregnancy, managing blood pressure, maintaining a healthy diet, and regular physical activity are proven strategies to reduce stroke risk. The American Stroke Association provides resources for stroke prevention and recovery at https://www.stroke.org.
"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," Qureshi said. He noted that there are currently no clinical guidelines specifically for managing these pregnancies, but he hopes the study will promote better identification and categorization of these women as high-risk from the beginning of their pregnancies.
The study's limitations include its observational nature and reliance on electronic health record data. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal. Abstracts presented at American Heart Association/American Stroke Association scientific meetings are not peer-reviewed but are curated by independent review panels. Additional information about the association's scientific integrity policies is available at https://www.heart.org/en/about-us/statements-and-policies.
For women considering pregnancy after stroke, the research provides essential data for informed decision-making. As stroke remains a significant health concern, with the American Heart Association's 2026 statistics indicating it is now the fourth leading cause of death in the U.S., understanding and addressing stroke risk during pregnancy represents a critical component of maternal healthcare and stroke prevention efforts nationwide.
