Adnan Qureshi, MD: Higher recurring stroke risk in pregnancy

Data presented this year at the American Stroke Association International Stroke Conference revealed that women with a history of previous ischemic stroke face significantly elevated risks during pregnancy and the early postpartum period. Adnan I. Qureshi, MD, Professor of Neurology, University of Missouri; Founder, Zeenat Qureshi Stroke Institutes, presented on the analysis of 220,479 pregnancies.

Quantifying the risk for counseling

The study found that the incident event rate of new ischemic stroke was 34.82% among pregnant women with a prior history, compared to just 0.34% among those without. After multivariable logistic regression and propensity-score adjustment, the results showed that women with a previous history of ischemic stroke had 2.37 times higher odds of a recurrent event (P < 0.0001). Other significant factors included previous myocardial infarction (OR 1.82) and obesity (OR 1.25).

“For women who actually had a previous ischemic stroke, I think now we have data to suggest that they do actually have a higher risk of having an ischemic stroke during pregnancy, and even the 6 weeks after pregnancy—the postpartum period,” Qureshi stated. He noted that this data is essential for patient decision-making: “They now have clear information to make a decision whether they actually want to go forward with the pregnancy or not.”

A call for high-risk classification

Qureshi emphasized that these findings should fundamentally change how these patients are classified and managed. Currently, high-risk pregnancy guidelines do not explicitly include a history of ischemic stroke as a primary component.

“If they actually want to go forward with the pregnancy, then the question becomes whether this is a high-risk pregnancy, and this data does suggest that it should be considered a high-risk pregnancy,” Qureshi said.

Multidisciplinary care needs

The study's conclusions suggested that care for these patients should be localized at centers geared toward high-risk management. Furthermore, Qureshi highlighted a gap in the current multidisciplinary approach.

“I think it does actually emphasize that perhaps the high-risk pregnancy team should actually involve stroke specialists or neurologists as part of that team,” he noted. By integrating neurological expertise into the obstetric care team, clinicians can better provide the monitoring and prevention tools necessary for this high-risk group.

Reference:

Qureshi A. Two Folds Higher Odds of Ischemic Stroke during Pregnancy and Post-partum Period in Women with a History of Ischemic Stroke. Abstract. Presented at: International Stroke Conference. February 5-7, 2026. Los Angeles, California.