Study Finds Women with Stroke History Face Doubled Risk of Recurrence During Pregnancy and Postpartum

Female stroke survivors were more than twice as likely as their stroke-free counterparts to have another stroke while pregnant and in the six weeks after childbirth, according to an analysis of a large national database of electronic health records. The preliminary study, to be presented at the American Stroke Association’s International Stroke Conference 2026, analyzed data from 220,479 pregnant women aged 15 to 50. Researchers found that among 1,192 pregnant women with a history of stroke, 415 new ischemic strokes occurred during pregnancy and soon after childbirth, representing a rate of 34.82%. In contrast, among 219,287 pregnant women without a prior stroke, only 737 new strokes occurred during the same period, a rate of 0.34%.

After adjusting for demographic and health factors, women with a history of prior stroke were more than twice as likely to have a second stroke during pregnancy and the early postpartum period compared with those who had no previous stroke. The study also found that the risk of ischemic stroke during pregnancy and the early postpartum period was 82% more likely among pregnant women who had a previous heart attack and 25% more likely in women with obesity. Study lead author Adnan I. Qureshi, M.D., a professor of neurology at the University of Missouri, stated that this increased risk is not influenced by other risk factors, providing crucial information for women and healthcare professionals making decisions about pregnancy after a stroke.

The findings underscore the need for intensified preventive efforts and specialized care for women with a history of ischemic stroke who are pregnant or planning 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. She emphasized that women with prior ischemic stroke should receive preconception counseling to discuss stroke risk and risk reduction strategies. An interdisciplinary team of neurologists and obstetricians can develop a surveillance and treatment plan during pregnancy and the postpartum period.

Researchers used the Oracle Health Real-World Data, a large U.S. national database of electronic health records, to analyze the rate of ischemic stroke in pregnant women between 2015 and 2025. They compared the rate of second stroke during pregnancy and in the postpartum period with the rate of first-time stroke during the same period. The study authors note that the observational analysis relies on data from electronic health records, which is a limitation of the findings. Future research will need to explore how specifically to lower the risk of a second stroke in this group of women.

Qureshi highlighted that there are currently no clinical guidelines for the management of these high-risk pregnancies. He expressed hope that this study will promote the identification and categorization of these women in the high-risk pregnancy group so they can receive a higher level of care from the beginning. Proven strategies to reduce the risk of additional strokes include identifying the cause of the first stroke, reviewing medications during pregnancy, managing blood pressure, eating a healthy diet, and regular physical activity. The American Heart Association provides additional resources on pregnancy and maternal health at https://www.heart.org. According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, stroke is now the #4 leading cause of death in the U.S., with more information available at https://www.stroke.org.