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 giving birth compared to women without such a history, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2026. The findings, based on an analysis of a large national database of electronic health records, provide critical data for women and healthcare providers making decisions about pregnancy after stroke.
The study analyzed electronic health records from U.S. hospitals between 2015 and 2025, focusing on 220,479 pregnant women aged 15 to 50. Researchers found that among 1,192 pregnant women with a history of ischemic stroke, 415 experienced a new stroke during pregnancy or the early postpartum period, representing 34.82%. In contrast, only 737 new strokes occurred among 219,287 pregnant women without a prior stroke history, a rate of 0.34%. After adjusting for demographic and health factors, women with a prior stroke were more than twice as likely to have a recurrent stroke during this critical period.
"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., a professor of neurology at the University of Missouri. The research also identified other risk factors: pregnant women with a history of heart attack faced an 82% increased risk of ischemic stroke, while women with obesity had a 25% increased risk.
The implications of these findings are significant for maternal healthcare. "Stroke during pregnancy or the early postpartum period can have devastating long-term consequences for the mother and her family," said Jennifer Lewey, M.D., M.P.H., chair of the writing committee of the 2024 American Heart Association Scientific Statement on postpartum cardiovascular risk, who was not involved in the study. She emphasized that "women with prior ischemic stroke should receive pre-conception counseling to discuss stroke risk during pregnancy and risk reduction" and advocated for interdisciplinary care teams.
Study authors recommend that preventive efforts should be intensified for women with a history of ischemic stroke 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 stressed that "attention should be brought to the fact that this is a very high-risk pregnancy" and that these women should be managed at healthcare centers experienced with high-risk pregnancies.
The study has limitations as an observational analysis relying on electronic health record data, and the findings are considered preliminary until published in a peer-reviewed journal. The research used the Oracle Health Real-World Data, a large U.S. national database available at https://www.oracle.com/health/. Patient perspectives highlight the real-world impact: Leslie Jordan, who experienced a stroke after her first childbirth and became pregnant again in 2025, emphasized the importance of proactive planning and specialized care teams.
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. More information is available at https://www.stroke.org. The American Stroke Association provides additional resources at their Stroke Hub available in English at https://www.stroke.org/en and in Spanish at https://www.stroke.org/es.
