A preliminary study analyzing electronic health records from U.S. hospitals found that women with a history of ischemic stroke face significantly increased risks during pregnancy and the postpartum period. According to research to be presented at the American Stroke Association's International Stroke Conference 2026, female stroke survivors were more than twice as likely to experience another stroke while pregnant and in the six weeks after childbirth compared to women without stroke history.
The analysis of 220,479 pregnant women ages 15 to 50 revealed stark differences in stroke rates. Among 1,192 pregnant women with previous stroke, 415 experienced new ischemic strokes during pregnancy or soon after childbirth, representing 34.82% of this group. In contrast, only 737 new strokes occurred among 219,287 pregnant women without stroke history, representing just 0.34% of that population. After adjusting for demographic and health factors, women with prior stroke remained more than twice as likely to have a second stroke during this critical period.
"A common question for women is whether to risk pregnancy after a previous ischemic stroke," said study lead author Adnan I. Qureshi, M.D., a professor of neurology at the University of Missouri. "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." The research utilized the Oracle Health Real-World Data, a large U.S. national database of electronic health records, to analyze stroke rates between 2015 and 2025.
The study also identified additional risk factors beyond prior stroke history. Pregnant women who had experienced a previous heart attack faced an 82% increased risk of ischemic stroke during pregnancy and the early postpartum period, while women with obesity had a 25% increased risk. These findings emphasize the complex interplay of cardiovascular risk factors during pregnancy.
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." Lewey, who was not involved in the current study, emphasized that "women with prior ischemic stroke should receive pre-conception counseling to discuss stroke risk during pregnancy and risk reduction." She also noted the importance of interdisciplinary care involving neurologists and obstetricians to develop surveillance and treatment plans.
The study authors recommend intensified preventive efforts for women with ischemic stroke history who become pregnant. Proven strategies to reduce stroke risk include identifying the cause of the first stroke, reviewing medications during pregnancy, managing blood pressure, maintaining a healthy diet, and engaging in regular physical activity. Qureshi stressed that "women who are pregnant and with a history of stroke should be managed at health care centers that have experience with high-risk pregnancies." He noted that while no clinical guidelines currently exist for managing these pregnancies, this study may help promote identification of these women as high-risk patients deserving specialized care.
Patient perspective illustrates the real-world implications of these findings. Leslie Jordan, who experienced an ischemic stroke after her first childbirth in 2018, became pregnant again in 2025 knowing she faced significant risks. She worked closely with her obstetrician and neurologist to create a proactive plan including daily blood thinner injections, baby aspirin, exercise, and a focused diet. "After my stroke, I knew this pregnancy would be high risk," said Jordan, who now volunteers for the American Stroke Association. "I focused on building a care team that understood my risks and could support me every step of the way."
The study's observational design and reliance on electronic health record data represent limitations, and the findings are considered preliminary until published in a peer-reviewed journal. However, the research provides important insights for clinical practice and patient counseling. According to the American Heart Association's 2026 Heart Disease and Stroke Statistics, stroke is now the fourth leading cause of death in the U.S., making these findings particularly relevant for maternal health. Additional information about stroke prevention and treatment is available through resources like www.stroke.org and www.DerrameCerebral.org.
