Ischemic Stroke During Pregnancy and the Postpartum Period
ISCHEMIC stroke during pregnancy occurred more often after prior ischemic stroke, with elevated odds through 6 week early postpartum.
Ischemic Stroke During Pregnancy: Higher Odds After Prior Stroke
New retrospective cohort findings suggest that women with a prior history of ischemic stroke face substantially higher odds of ischemic stroke during pregnancy and the early postpartum period. The study assessed incident ischemic stroke occurring during pregnancy or within 42 days after delivery and compared outcomes between pregnancies in women with and without a documented history of ischemic stroke.
What the Cohort Study Found
Investigators analyzed electronic health record data spanning January 2015 to February 2025 and identified 220,479 completed pregnancies. Prior ischemic stroke history was identified using ICD-10-CM codes, and incident ischemic stroke during pregnancy or within 42 days postpartum was similarly captured using diagnosis coding.
Incident ischemic stroke was recorded in 415 of 1,192 pregnancies among women with a prior ischemic stroke history, compared with 737 of 219,287 pregnancies among women without such a history. After 1:10 propensity score matching by demographics and comorbidities and multivariable logistic regression, prior ischemic stroke history remained associated with significantly higher risk of ischemic stroke during pregnancy or the early postpartum period (OR 2.37; 95% CI: 1.97–2.87; p<0.0001).
Two additional factors were associated with recurrent ischemic stroke during pregnancy or early postpartum: previous myocardial infarction (OR 1.82; 95% CI: 1.38–2.39; p<0.0001) and obesity (OR 1.25; 95% CI: 1.07–1.47; p<0.01). The analysis also reported higher odds of incident ischemic stroke among women with prior ischemic stroke who were pregnant or early postpartum compared with those with neither condition (OR 3.35; 95% CI: 2.67–4.22; p<0.0001).
Clinical Relevance for U.S. Practice
These findings reinforce the importance of structured counseling, close surveillance, and strengthened secondary prevention planning for pregnant patients with a prior ischemic stroke history, particularly across pregnancy and the early postpartum period.
Reference: Qureshi A et al. Risk of Ischemic Stroke during Pregnancy and Post-partum Period in Women with a Prior History of Ischemic Stroke. Int J Stroke. 2026;doi:10.1177/17474930261416693.
