Women who have experienced an ischemic stroke face more than double the risk of having another stroke during pregnancy and within six weeks after childbirth, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2026. The study analyzed electronic health records from hospitals across the United States, comparing stroke rates among pregnant women with and without previous stroke histories between 2015 and 2025.
The analysis revealed that among 1,192 pregnant women with a history of stroke, 415 experienced new ischemic strokes during pregnancy or the early postpartum period, representing 34.82% of this group. In contrast, only 737 new strokes occurred among 219,287 pregnant women without prior stroke history, amounting to just 0.34%. After adjusting for demographic and health factors, researchers determined that women with previous stroke were more than twice as likely to experience another stroke during this critical period compared to those without stroke history.
Study lead author Adnan I. Qureshi, M.D., emphasized that this increased risk exists independently of other factors. "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 Qureshi, a professor of neurology at the University of Missouri and founder of Zeenat Qureshi Stroke Institutes. He noted that these findings should help women and healthcare professionals make more informed decisions about pregnancy risks.
The research also identified additional risk factors. Pregnant women with a history of heart attack showed an 82% increased likelihood of ischemic stroke during pregnancy and the postpartum period, while women with obesity faced a 25% higher risk. 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 disease 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 and serves as assistant professor of medicine at the University of Pennsylvania Perelman School of Medicine, stressed that women with prior ischemic stroke should receive preconception counseling to discuss stroke risk during pregnancy and risk reduction strategies. She recommended that interdisciplinary teams of neurologists and obstetricians develop surveillance and treatment plans for pregnancy and postpartum periods.
The study's implications extend to clinical practice and patient care. Qureshi emphasized that "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." He noted that no clinical guidelines currently exist for managing these pregnancies and expressed hope that this study would promote identification and categorization of these women as high-risk pregnancy cases deserving specialized care.
Researchers used the Oracle Health Real-World Data, a large U.S. national database of electronic health records, for their analysis of 220,479 pregnant women aged 15 to 50. The participant population consisted of 60.74% white women, 21.81% Black women, 1.34% Asian women, 0.17% Native American women, and 15.94% women of other races. Study authors acknowledge that as an observational analysis relying on database information, the findings have limitations and require further research to explore specific methods for lowering second stroke risk in this population.
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. The American Heart Association provides additional resources through their Stroke Hub and emphasizes that stroke remains a significant health concern, currently ranking as the fourth leading cause of death in the United States according to their 2026 statistics.
