A new scientific statement from the American Heart Association, endorsed by the American College of Obstetricians & Gynecologists, details risk factors for pregnancy-related stroke and offers comprehensive suggestions for prevention, rapid diagnosis, timely treatment, and recovery. Published in the Association's journal Stroke, the statement emphasizes that while stroke during pregnancy or shortly after delivery is rare, it can be life-threatening and requires increased awareness and coordinated care.
According to the statement's writing group chair, Dr. Eliza Miller, stroke during these periods can lead to serious complications for both mother and baby, including neurological deficits, long-term disability, increased risk of future strokes, and death. The statement notes that stroke occurs in approximately 20 to 40 of every 100,000 pregnancies and accounts for around 4-6% of pregnancy-related deaths annually in the U.S., based on data from the American Heart Association's 2026 Heart Disease and Stroke Statistics.
The physiological changes of pregnancy, including vascular system alterations and hormonal shifts, contribute to stroke risk. Other identified risk factors include chronic hypertension, hypertensive disorders of pregnancy like preeclampsia, advanced maternal age (35 or older), diabetes, obesity, migraine with aura, infections, heart or cerebrovascular disease, and clotting disorders. The statement highlights significant disparities, noting that 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.
Emphasis is placed on primary prevention beginning 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, such as smoking cessation, healthy eating, physical activity, and weight management. The statement asserts that the majority of maternal strokes are preventable with earlier, more aggressive blood pressure control, referencing the Association's 2025 High Blood Pressure Guideline, which uses ACOG's diagnostic criteria for hypertension in pregnancy.
Dr. Miller stressed that the early postpartum period is the highest risk time for stroke, making very close blood pressure monitoring essential. Treating high blood pressure during pregnancy and postpartum with medication may help prevent complications, and previous studies indicate daily low-dose aspirin significantly reduces preeclampsia risk in high-risk individuals. Observational data also suggest tighter blood pressure control after delivery decreases postpartum emergency department visits and hospital readmissions.
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 like computed tomography and magnetic resonance imaging without contrast are deemed safe for rapid evaluation. The authors emphasize pregnancy should not delay recommended acute stroke treatment, noting various anti-clotting medications are safe for pregnant and lactating women, with mechanical thrombectomy available for large-vessel blockages.
Regarding delivery and recovery, the writing group notes stroke during pregnancy is not an automatic indication for immediate delivery if the mother is stable and the fetus is preterm, though preterm delivery may be necessary if the mother's condition worsens. Survivors face unique challenges like infant care and require multidisciplinary rehabilitation support. Mood and sleep disorders, post-stroke fatigue, anxiety, and depression are common and may be intensified by postpartum factors; these can be managed with behavioral therapy, counseling, and medication. Engaging family members and support networks in rehabilitation planning is highlighted as important for improving recovery and long-term health outcomes.
The statement calls for more research on maternal stroke, including clinical trials, to refine risk assessment, expand treatment options, and improve maternal and fetal health, addressing a historical gap due to ethical concerns about including pregnant women in trials.
