Women who have survived an ischemic stroke face more than double the risk of experiencing another stroke during pregnancy and in the six weeks after childbirth compared to those without such history, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2026. The findings, based on analysis of electronic health records from U.S. hospitals, provide crucial data for women and healthcare providers making decisions about pregnancy after stroke.
The study analyzed data from 220,479 pregnant women aged 15 to 50, comparing stroke rates between those with and without previous ischemic stroke history between 2015 and 2025. Researchers found that among 1,192 pregnant women with prior stroke history, 415 experienced new 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 stroke history, representing just 0.34% of that population.
After adjusting for demographic and health factors, women with prior stroke history were more than twice as likely to have a second stroke during pregnancy and the early postpartum period. The analysis also revealed that pregnant women with previous heart attacks faced an 82% increased risk of ischemic stroke during this period, while women with obesity faced a 25% increased risk. The research utilized the Oracle Health Real-World Data, a large national database of electronic health records, to conduct this analysis.
"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., professor of neurology at the University of Missouri. "Now, women and their health care professionals can make a more informed decision about the risks related to 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. 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 benefit from interdisciplinary care teams.
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 regular physical activity. Qureshi emphasized that "attention should be brought to the fact that this is a very high-risk pregnancy" and that affected women should be managed at healthcare centers experienced with high-risk pregnancies.
Patient perspective illustrates the practical 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 specialists to develop a proactive plan including blood thinners, baby aspirin, exercise, and dietary modifications. "After my stroke, I knew this pregnancy would be high risk. I focused on building a care team that understood my risks and could support me every step of the way," said Jordan, who now volunteers for the American Stroke Association.
The study represents an observational analysis with limitations inherent to database research, and the findings are considered preliminary until published in a peer-reviewed journal. However, the data provides important insights for healthcare providers and policymakers developing guidelines for managing high-risk pregnancies. 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 healthcare. Additional information about stroke prevention and treatment is available at https://www.stroke.org and https://www.DerrameCerebral.org.
