New Guidelines Address Stroke Prevention and Treatment During Pregnancy and Postpartum

Stroke during pregnancy or shortly after delivery, while rare, represents a serious threat to maternal and fetal health, according to a new scientific statement from the American Heart Association. The statement, published in the journal Stroke and endorsed by the American College of Obstetricians & Gynecologists, details risk factors and offers guidance for prevention, rapid diagnosis, treatment, and 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 Dr. Eliza Miller, chair of the writing group.

Stroke is the fourth leading cause of death in the U.S., and it occurs in approximately 20 to 40 of every 100,000 pregnancies, accounting for an estimated 4-6% of pregnancy-related deaths annually. The statement identifies key risk factors, including chronic hypertension, hypertensive disorders of pregnancy like preeclampsia, advanced maternal age, diabetes, obesity, and migraine with aura. It also notes that stroke disproportionately affects racial and ethnic minorities, with pregnant Black women being twice as likely to have a stroke compared to pregnant white women, even after adjusting for socioeconomic factors.

The authors emphasize that primary prevention ideally begins before conception. Women considering pregnancy are encouraged to follow strategies detailed in 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. 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 diagnostic criteria for hypertension in pregnancy, defined as systolic blood pressure greater than or equal to 140 mm Hg or diastolic blood pressure greater than or equal to 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,’ Miller said. Treating high blood pressure during pregnancy and postpartum with medication may help prevent complications. Previous studies have found that daily low-dose aspirin significantly reduces the risk of preeclampsia in high-risk individuals.

For diagnosis and treatment, the statement urges all healthcare professionals who care for pregnant patients to be trained to recognize stroke symptoms to promptly start treatment. Diagnosing a stroke using imaging techniques is safe for rapid evaluation of pregnant patients. The authors emphasize that pregnancy is not a reason to delay recommended treatment for acute stroke, and various anti-clotting medications are safe for pregnant and lactating women.

Regarding delivery and recovery, the writing group notes that stroke during pregnancy is not an automatic indication for immediate delivery if the mother’s condition is stable. 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. ‘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. The statement calls for more research, including clinical trials, to refine stroke risk assessment and expand treatment options.

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