ISC 2026 | Risk of ischemic stroke during pregnancy and post-partum in women with a history of ischemic stroke

So as stroke specialists, we are frequently faced with the question that young women who have had an ischemic stroke and want to actually have a pregnancy and whether they actually are at a higher risk for having a stroke during pregnancy or in the immediate period that follows pregnancy. And a lot of time, we are giving advice based on opinion, but we just don’t have the necessary data to give an objective advice. So what our study did was it took over 220,000 pregnancies. And it looked at women who actually had a previous history of ischemic stroke and compared it to the women who did not have a history of ischemic stroke. And what we found is that women who had a previous history of ischemic stroke had a much higher chance of actually having a stroke either during pregnancy or in the six weeks following pregnancy. And even if you adjust for all the other reasons that they could have had a stroke, still just the history of having an ischemic stroke, there was a twofold higher risk of odds of actually having another stroke during pregnancy or the immediate period following pregnancy. And some of the other things that actually increased the risk were previous history of myocardial infarction, obesity. And interestingly, women who actually took aspirin or blood pressure medication seemed to have a low risk of having a stroke during pregnancy or the immediate period following pregnancy. So the implications, you know, one is awareness and it’s a bidirectional awareness. So obviously it’s an awareness among women that if they choose to have a pregnancy, they may be actually facing a higher risk of having an ischemic stroke. But it’s also our awareness and recognition on the medical professionals as well, because we never really knew what was the risk, whether it was truly increased and to what magnitude. And now, so where we stand now is how do we take this and apply it to clinical practice? So there is actually a category called high-risk pregnancy, but a previous history of ischemic stroke is not part of that high-risk pregnancy. So obviously there probably needs to be, the definition of high-risk pregnancy needs to be expanded to be inclusive of the history of previous ischemic stroke. And there’s also guidelines on how to manage in high-risk pregnancy. So essentially, what it requires is a multidisciplinary team, but there is no guidance on the stroke specialist or a neurologist needing to be part of it. So it looks like in this particular high-risk pregnancy, they need to be involved so that the patients or the women can get the best advice and best counseling possible. The lower risk of actually having a stroke with aspirin and blood pressure medication is a good message, which says that the stroke can be mitigated, can be reduced with the appropriate medication. But obviously, that’s something clinical trials would actually have to evaluate in more detail whether these medications actually are truly beneficial and at what time frame in pregnancy should they be initiated and concluded, whether it should be immediately after pregnancy or certain weeks after pregnancy.

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