Stroke during pregnancy or shortly after delivery is rare, yet it can be life-threatening. Increased awareness and coordinated care of women during pregnancy for stroke risk factors, diagnosis, treatment and recovery are crucial to the health of both mother and baby affected by a stroke, according to a new American Heart Association scientific statement published today in the Association’s journal Stroke and endorsed by the American College of Obstetricians & Gynecologists.
The new scientific statement, “Prevention and Treatment of Maternal Stroke in Pregnancy and Postpartum,” summarizes the latest scientific research detailing the risk factors and causes of stroke during and after pregnancy, and offers suggestions for maternal stroke prevention, management and postpartum recovery.
“When a stroke occurs during pregnancy or the postpartum period, it can lead to serious complications for both the mother and baby, including neurological deficits, long-term disability, increased risk of future strokes and death,” said Eliza Miller, M.D., M.S., chair of the writing group and associate professor of neurology and chief of women’s neurology at the University of Pittsburgh in Pennsylvania. “Controlling blood pressure and other stroke risks before and after delivery, responding immediately to stroke warning signs and providing timely treatment can help save lives and improve outcomes for mothers and their babies,” Miller said.
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. There are two types of stroke: an ischemic stroke is when a blood vessel supplying blood to the brain is blocked by a clot, and a hemorrhagic stroke is when a blood vessel ruptures and bleeds into the brain. A stroke occurs in approximately 20 to 40 of every 100,000 pregnancies, and stroke is estimated to account for around 4-6% of pregnancy-related deaths annually in the U.S.
Pregnant and postpartum women have historically been excluded from clinical trials due to ethical concerns about the safety to the pregnant woman and the fetus. As a result, there is limited evidence for health care professionals to manage stroke in these patients. Over the past decade, however, a growing body of observational research has emerged to inform optimal care.
Risk factors for stroke during and after pregnancy
The physiological changes that occur during pregnancy, including changes within the vascular system (vessels that carry blood throughout the body) and hormonal shifts, can contribute to a woman’s risk of stroke. Other risk factors for pregnancy-associated stroke include:
- Chronic hypertension (high blood pressure before pregnancy or diagnosed before 20 weeks of pregnancy)
- Hypertensive disorders of pregnancy, such as gestational hypertension and preeclampsia/eclampsia
- Advanced maternal age (defined as 35 years or older)
- Diabetes
- Obesity
- Migraine, particularly with aura
- Infections
- Heart or cerebrovascular disease
- Clotting disorders
As with other differences in maternal health outcomes, stroke disproportionately affects people of racial and ethnic minorities. 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.
Emphasis on primary prevention
The statement authors emphasize that lowering risks of pregnancy-related stroke ideally begins before conception. Women who are 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, such as smoking cessation, healthy eating, recommended physical activity and weight management.
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, defined as systolic blood pressure (the top number) ≥140 mm Hg or diastolic blood pressure (the bottom number) ≥90 mm Hg.
“Preeclampsia and eclampsia can occur before, during or after delivery, and the early postpartum period is actually the highest risk time for stroke. Very close monitoring of blood pressure is essential,” said Miller.
Treating high blood pressure during pregnancy and postpartum with antihypertensive medication may help prevent the complications associated with severe hypertension and preeclampsia. Previous studies have found that daily low-dose aspirin significantly reduces the risk of preeclampsia in high-risk individuals compared with placebo. Observational data also suggest a correlation between tighter blood pressure control after delivery and decreased rates of postpartum emergency department visits and hospital readmissions.
Diagnosis and treatment of maternal stroke
The statement urges all health care professionals who care for pregnant patients, including obstetricians, family medicine practitioners and nurses, to be trained to recognize stroke symptoms so they can promptly start treatment and potentially minimize stroke-related complications.
“It is crucial for women who are pregnant or have recently given birth and have symptoms of new neurological deficits or severe headache, especially if they also have elevated blood pressure, to be immediately evaluated for possible stroke,” said Miller.
Diagnosing a stroke using imaging techniques, including computed tomography, computed tomography angiography and magnetic resonance imaging without contrast, are all safe for rapid evaluation of pregnant patients with acute stroke symptoms.
The statement authors emphasize that pregnancy is not a reason to delay or interfere with recommended treatment for acute stroke. There are various anti-clotting medications available that are safe for pregnant and lactating women. Mechanical thrombectomy (surgical removal of a blood clot) may be needed for patients with large-vessel blockages.
Considerations for delivery and recovery after stroke
The writing group notes that stroke during pregnancy is not an indication for immediate delivery if the mother’s condition is stable and the fetus is preterm (before 37 weeks of gestation). If, however, the mother’s neurological or cardiovascular status worsens, preterm delivery may be necessary. When possible, it is preferable to avoid cesarean delivery to minimize the associated surgical risks and changes in blood pressure.
Survivors of pregnancy-associated stroke face unique challenges such as 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 such as hormonal shifts, breastfeeding and disrupted sleep. Post-stroke fatigue, anxiety and depression can occur in stroke survivors and are linked to worse outcomes. These conditions may be managed with behavioral therapy, counseling with mental health specialists and medication as needed. Engaging patients’ family members, caregivers and support networks in rehabilitation planning and goal setting is also important to improve recovery and long-term health outcomes.
“Babies depend on their mothers’ well-being, and supporting recovery after stroke, both emotionally and practically, is essential so mothers can heal and families can thrive,” Miller said.
