A new scientific statement from the American Heart Association, published today in the journal Stroke and endorsed by the American College of Obstetricians & Gynecologists, highlights the need for increased awareness and coordinated care to prevent and treat stroke during pregnancy and the postpartum period. Although maternal stroke is rare, it can be life-threatening, and the statement provides updated guidance on risk factors, prevention, diagnosis, treatment, and recovery.
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, accounting for around 4-6% of pregnancy-related deaths annually. Risk factors include chronic hypertension, preeclampsia, advanced maternal age, diabetes, obesity, migraine with aura, infections, heart or cerebrovascular disease, and clotting disorders. Racial disparities persist, with a 2020 meta-analysis finding that pregnant Black women are twice as likely to have a stroke compared to pregnant white women, even after adjusting for socioeconomic factors.
The statement emphasizes primary prevention beginning before conception. Women considering pregnancy are encouraged to follow primary stroke prevention strategies from the 2024 American Heart Association/American Stroke Association Guideline for the Primary Prevention of Stroke and adopt healthy lifestyle behaviors from Life’s Essential 8, including smoking cessation, healthy eating, physical activity, and weight management. The majority of maternal strokes are preventable with earlier and more aggressive blood pressure control. The Association’s 2025 High Blood Pressure Guideline uses ACOG’s diagnostic criteria for hypertension in pregnancy, defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥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 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. Treating high blood pressure with antihypertensive medication and daily low-dose aspirin in high-risk individuals can help prevent complications. Observational data suggest tighter blood pressure control after delivery reduces postpartum emergency department visits and hospital readmissions.
The statement urges all health care professionals caring for pregnant patients to be trained to recognize stroke symptoms and promptly start treatment. Imaging techniques such as computed tomography, computed tomography angiography, and magnetic resonance imaging without contrast are safe for rapid evaluation. Pregnancy is not a reason to delay recommended acute stroke treatment; anti-clotting medications safe for pregnant and lactating women are available, and mechanical thrombectomy may be used for large-vessel blockages.
For delivery and recovery, stroke during pregnancy is not an immediate indication for delivery if the mother is stable and the fetus is preterm. Avoiding cesarean delivery when possible minimizes surgical risks and blood pressure changes. Survivors face unique challenges such as caring for an infant and require multidisciplinary rehabilitation. Mood and sleep disorders are common and may be intensified by postpartum factors. Post-stroke fatigue, anxiety, and depression can be managed with behavioral therapy, counseling, and medication. Engaging family members and support networks in rehabilitation planning is essential for recovery.
