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 journal Stroke, emphasizes that while stroke during pregnancy or shortly after delivery is rare, it can be life-threatening, and increased awareness and coordinated care are crucial for maternal and fetal health.
Stroke prevention strategies during pregnancy and postpartum include risk factor modification through healthy lifestyle behaviors, managing high blood pressure, and using anti-clotting medications if needed. 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 U.S. There are two types of stroke: an ischemic stroke, when a blood vessel supplying blood to the brain is blocked by a clot, and a hemorrhagic stroke, when a blood vessel ruptures and bleeds into the brain.
Risk factors for stroke during and after pregnancy include chronic hypertension, hypertensive disorders of pregnancy like preeclampsia/eclampsia, advanced maternal age (35 years or older), diabetes, obesity, migraine with aura, infections, heart or cerebrovascular disease, and clotting disorders. The statement notes that stroke disproportionately affects people of racial and ethnic minorities, with a 2020 meta-analysis finding pregnant Black women are twice as likely to have a stroke compared to pregnant white women, even after adjusting for socioeconomic factors.
The statement authors emphasize that lowering risks of pregnancy-related stroke ideally begins before conception. Women considering pregnancy are encouraged to follow primary stroke prevention strategies detailed in the 2024 American Heart Association/American Stroke Association Guideline for the Primary Prevention of Stroke, as well as healthy lifestyle behaviors included in Life’s Essential 8. 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. Previous studies have found daily low-dose aspirin significantly reduces preeclampsia risk in high-risk individuals. For diagnosis, the statement urges all health care professionals who care for pregnant patients to be trained to recognize stroke symptoms for prompt treatment. Imaging techniques like computed tomography are safe for rapid evaluation of pregnant patients with acute stroke symptoms.
The statement emphasizes that pregnancy is not a reason to delay recommended treatment for acute stroke, with various anti-clotting medications available that are safe for pregnant and lactating women. For recovery, survivors of pregnancy-associated stroke face unique challenges like 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. More research on maternal stroke, including clinical trials, is needed to refine stroke risk assessment, expand treatment options, and improve maternal and fetal health.
