New Guidelines Aim to Reduce Rising Rates of Stroke During and After Pregnancy
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A new scientific statement from the american Heart Association details critical risk factors for pregnancy-related stroke and offers guidance for prevention, diagnosis, and recovery.
Stroke during pregnancy or shortly after childbirth, while rare, poses a significant and perhaps life-threatening risk to both mother and baby. Recognizing this growing concern, the American Heart Association (AHA), with endorsement from the American College of Obstetricians & Gynecologists (ACOG), has released a comprehensive scientific statement outlining strategies for improved awareness, coordinated care, and ultimately, better outcomes. The statement, published today in the AHA journal Stroke, emphasizes the need for proactive measures to address this increasingly recognized health challenge.
“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,” explained Eliza Miller, M.D., M.S., chair of the writing group and associate professor of 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 definitely help save lives and improve outcomes for mothers and their babies.”
According to the AHA’s 2026 Heart Disease and Stroke statistics, stroke is now the fourth leading cause of death in the United States. During pregnancy, stroke occurs in approximately 20 to 40 of every 100,000 pregnancies and accounts for an estimated 4-6% of pregnancy-related deaths annually. These figures underscore the urgency for improved preventative measures and rapid response protocols.
The Unique Challenges of Maternal Stroke
Historically, pregnant and postpartum women have been largely excluded from clinical trials due to ethical considerations surrounding the safety of both mother and fetus. This lack of dedicated research has resulted in limited evidence-based guidelines for managing stroke in this specific population. However, a growing body of observational research over the past decade is now informing best practices.
The physiological changes inherent in pregnancy – including alterations to the vascular system and hormonal shifts – contribute to a woman’s increased stroke risk. Specific risk factors include chronic hypertension, hypertensive disorders of pregnancy such as gestational hypertension and preeclampsia/eclampsia, advanced maternal age (35 years or older), diabetes, obesity, migraine with aura, infections, pre-existing heart or cerebrovascular disease, and clotting disorders.
Disparities in Maternal Stroke Incidence
A concerning trend highlighted in the statement is the disproportionate impact of stroke on racial and ethnic minorities. A 2020 meta-analysis revealed that pregnant Black women are twice as likely to experience a stroke compared to their white counterparts,even after accounting for socioeconomic factors. This disparity underscores the need for targeted interventions and equitable access to care.
Prioritizing Prevention Before and During Pregnancy
The statement’s authors strongly advocate for a proactive approach, emphasizing that risk reduction should ideally begin before conception. women planning a pregnancy are encouraged to adopt primary stroke prevention strategies outlined in the 2024 AHA/ASA Guideline for the Primary Prevention of Stroke, alongside embracing healthy lifestyle behaviors encompassed in Life’s Essential 8 – including smoking cessation, a balanced diet, regular physical activity, and weight management.
Aggressive blood pressure control is paramount, with the statement noting that the majority of maternal strokes are preventable through earlier and more effective management of hypertension. The AHA’s 2025 High Blood Pressure Guideline aligns with ACOG’s diagnostic criteria, defining hypertension in pregnancy as a systolic blood pressure of 140 mm hg or higher, or a diastolic blood pressure of 90 mm Hg or higher.
“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,” Miller emphasized. Low-dose aspirin has been shown to substantially reduce the risk of preeclampsia in high-risk individuals.
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