New Scientific Statement Details Strategies for Preventing and Treating Stroke During and After Pregnancy

The American Heart Association, in a scientific statement endorsed by the American College of Obstetricians & Gynecologists, has detailed comprehensive strategies for stroke prevention, diagnosis, treatment, and recovery during pregnancy and postpartum. Published in the journal Stroke, the statement addresses a rare but life-threatening condition that accounts for approximately 4-6% of pregnancy-related deaths annually in the U.S., occurring in about 20 to 40 of every 100,000 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., highlighting the urgency of this maternal health issue.

Dr. Eliza Miller, chair of the writing group and associate professor of neurology at the University of Pittsburgh, emphasized the severe consequences of maternal stroke, including neurological deficits, long-term disability, increased risk of future strokes, and death for both mother and baby. The statement identifies key risk factors, including chronic hypertension, hypertensive disorders of pregnancy like preeclampsia/eclampsia, advanced maternal age (35 or older), diabetes, obesity, migraine with aura, infections, heart or cerebrovascular disease, and clotting disorders. Notably, a 2020 meta-analysis found that pregnant Black women are twice as likely to have a stroke compared to pregnant white women, even after adjusting for socioeconomic factors, underscoring racial disparities in maternal health outcomes.

Primary prevention is a central focus, with the authors recommending that risk reduction begin before conception. Women considering pregnancy are encouraged to follow strategies outlined in the 2024 American Heart Association/American Stroke Association Guideline for the Primary Prevention of Stroke and adopt healthy lifestyle behaviors from Life’s Essential 8, such as smoking cessation, healthy eating, physical activity, and weight management. The statement asserts that most maternal strokes are preventable with earlier and 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 noted that the early postpartum period is the highest risk time for stroke, making close blood pressure monitoring essential, and that treating high blood pressure with antihypertensive medication may help prevent complications.

For diagnosis and treatment, the statement urges all healthcare professionals caring for pregnant patients to be trained to recognize stroke symptoms to enable prompt intervention. Imaging techniques like computed tomography and magnetic resonance imaging without contrast are deemed safe for rapid evaluation. Importantly, pregnancy should not delay recommended acute stroke treatments, including anti-clotting medications safe for pregnant and lactating women and mechanical thrombectomy for large-vessel blockages. Regarding delivery, 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, with a preference to avoid cesarean delivery to minimize surgical risks.

Recovery after stroke presents unique challenges, such as caring for an infant, and requires support from a multidisciplinary rehabilitation team. Mood and sleep disorders, common after stroke, may be intensified by postpartum factors like hormonal shifts and breastfeeding, and can be managed with behavioral therapy, counseling, and medication. Engaging family members and caregivers in rehabilitation planning is crucial for improving long-term outcomes. The statement calls for more research, including clinical trials, to refine stroke risk assessment and expand treatment options, as pregnant and postpartum women have historically been excluded from trials due to ethical concerns, limiting evidence for optimal care. This guidance aims to enhance maternal and fetal health through coordinated, evidence-based approaches to stroke prevention and management.