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 suggestions for stroke prevention, rapid diagnosis, timely treatment and recovery during pregnancy and postpartum. The statement, published in the Association's journal Stroke, 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 American Heart Association's 2026 Heart Disease and Stroke Statistics, stroke is now the fourth leading cause of death in the U.S. A stroke occurs in approximately 20 to 40 of every 100,000 pregnancies, and stroke accounts for around 4-6% of pregnancy-related deaths annually in the country. The statement authors note that pregnant and postpartum women have historically been excluded from clinical trials due to ethical concerns, resulting in limited evidence for health care professionals to manage stroke in these patients.
Risk factors for pregnancy-associated stroke include chronic hypertension, hypertensive disorders of pregnancy such as preeclampsia/eclampsia, advanced maternal age (35 years or older), diabetes, obesity, migraine with aura, infections, heart or cerebrovascular disease, and clotting disorders. The statement highlights that stroke disproportionately affects people of racial and ethnic minorities, with a 2020 meta-analysis finding that pregnant Black women are twice as likely to have a stroke compared to pregnant white women, even after adjusting for socioeconomic factors.
The majority of maternal strokes are preventable with earlier and more aggressive blood pressure control, according to the statement. The Association's 2025 High Blood Pressure Guideline uses ACOG's diagnostic criteria for hypertension in pregnancy. Treating high blood pressure during pregnancy and postpartum with antihypertensive medication may help prevent complications associated with severe hypertension and preeclampsia. Previous studies have found that daily low-dose aspirin significantly reduces the risk of preeclampsia in high-risk individuals compared with placebo.
The statement urges all health care professionals who care for pregnant patients to be trained to recognize stroke symptoms so they can promptly start treatment and potentially minimize stroke-related complications. Diagnosing a stroke using imaging techniques, including computed tomography, computed tomography angiography and magnetic resonance imaging without contrast, are all safe for rapid evaluation of pregnant patients with acute stroke symptoms. The authors emphasize that pregnancy is not a reason to delay or interfere with recommended treatment for acute stroke, and there are various anti-clotting medications available that are safe for pregnant and lactating women.
Survivors of pregnancy-associated stroke face unique challenges such as caring for an infant and require support from a multidisciplinary rehabilitation team. Mood and sleep disorders are common after stroke and may be intensified by postpartum factors such as hormonal shifts, breastfeeding and disrupted sleep. Post-stroke fatigue, anxiety and depression can occur in stroke survivors and are linked to worse outcomes. These conditions may be managed with behavioral therapy, counseling with mental health specialists and medication as needed.
The statement represents a significant advancement in maternal healthcare by providing evidence-based guidance where limited clinical trial data previously existed. For business and technology leaders in healthcare, this development highlights the importance of implementing systematic screening protocols, investing in healthcare provider education, and developing support systems for postpartum recovery. The emphasis on preventive care and early intervention presents opportunities for healthcare technology solutions focused on remote monitoring, risk assessment algorithms, and coordinated care platforms that can improve outcomes for this vulnerable population.
