A new AHA scientific statement outlines how earlier prevention, rapid diagnosis and timely treatment can reduce the risks of maternal stroke during pregnancy and postpartum.
Though rare, stroke still remains a life-threatening complication of pregnancy with potential implications for both maternal and fetal health. This, combined with the American Heart Association (AHA) noting limited guidance in current stroke prevention and treatment guidelines, has led the AHA to release a scientific statement that details “risk factors for pregnancy-related stroke and offers suggestions for stroke prevention, rapid diagnosis, timely treatment and recovery during pregnancy and postpartum.” The statement was published on January 28, 2026, in the AHA journal Stroke, and endorsed by the American College of Obstetrics & Gynecologists (ACOG).1,2
According to the statement, stroke occurs in approximately 20 to 40 of every 100,000 pregnancies and is estimated to account for around 4% to 6% of pregnancy-related deaths annually in the United States. Approximately half of all pregnancy-associated stroke hospitalizations in the United States occur in the setting of hypertensive disorders, highlighting the role of optimal blood pressure management.1
Physiological changes during pregnancy, including vascular adaptations and hormonal shifts, can increase stroke risk. Additional risk factors identified include chronic hypertension, hypertensive disorders of pregnancy such as gestational hypertension and preeclampsia/eclampsia, advanced maternal age (35 years or older), diabetes, obesity, migraine (particularly with aura), infections, heart or cerebrovascular disease, and clotting disorders.2
Stroke disproportionately affects people of racial and ethnic minorities, with evidence from a 2020 meta-analysis demonstrating that pregnant Black women are twice as likely to experience a stroke compared with pregnant White women, even after adjustment for socioeconomic factors.
“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 Eliza Miller, MD, MS, chair of the writing group; associate professor, neurology; chief, women’s neurology, University of Pittsburgh, in a statement. “Controlling blood pressure and other stroke risks before and after delivery, responding immediately to stroke warning signs and providing timely treatment can help save lives and improve outcomes for mothers and their babies.”
Stroke is now the fourth-leading cause of death in the United States, according to data from the AHA’s 2026 Heart Disease Stroke Statistics.3 As such, the statement stresses that stroke prevention ideally begins before conception. Women considering pregnancy are encouraged to follow primary prevention strategies outlined in the 2024 AHA/American Stroke Association Guideline for the Primary Prevention of Stroke, along with healthy lifestyle behaviors included in Life’s Essential 8, such as smoking cessation, healthy eating, physical activity, and weight management.2,4
According to the 2024 guide, the following are the AHA’s Top 10 take-home messages:
“1. From birth to old age, every person should have access to and regular visits with a primary care health professional to identify and achieve opportunities to promote brain health.
2. Screening for and addressing adverse social determinants of health are important in the approach to prevention of incident stroke. This updated guideline includes an orientation to social determinants of health, acknowledging its impact on access to care and treatment of stroke risk factors. Therefore, screening for social determinants of health is recommended in care settings where at-risk stroke patients may be evaluated, with the acknowledgment that evidence-based interventions to address adverse social determinants of health are evolving.
3. The Mediterranean diet is a dietary pattern that has been shown to reduce the risk of stroke, especially when supplemented with nuts and olive oil. However, low-fat diets have had little impact on reducing the risk. This guideline recommends that adults with no prior cardiovascular disease and those with high or intermediate risk adhere to the Mediterranean diet.
4. Physical activity is essential for cardiovascular health and stroke risk reduction. This guideline includes a summary of high-quality data showing that prolonged sedentary behavior during waking hours is associated with an increased risk of stroke. Therefore, we provide a new recommendation for screening for sedentary behavior and counseling patients to avoid being sedentary, as well as a call for new studies of interventions to disrupt sedentary behavior. This is in addition to the recommendation to engage in regular moderate to vigorous physical activity.
5. Glucagon-like protein-1 receptor agonists have been shown to be effective not only for improving management of type 2 diabetes but also for weight loss and lowering the risk of cardiovascular disease and stroke. On the basis of these robust data, we provide a new recommendation for the use of these drugs in patients with diabetes and high cardiovascular risk or established cardiovascular disease.
6. Blood pressure management is critical for stroke prevention. Randomized controlled trials have demonstrated that treatment with 1 antihypertensive medication is effective for reaching the blood pressure goal in only ≈30% of participants and that the majority of participants achieved the goal with 2 or 3 medications. Therefore, ≥2 antihypertensive medications are recommended for primary stroke prevention in most patients who require pharmacological treatment of hypertension.
7. Antiplatelet therapy is recommended for patients with antiphospholipid syndrome or systemic lupus erythematosus without a history of stroke or unprovoked venous thromboembolism to prevent stroke. Patients with antiphospholipid syndrome who have had a prior unprovoked venous thrombosis likely benefit from vitamin K antagonist therapy (target international normalized ratio, 2–3) over direct oral anticoagulants.
8. Prevention of pregnancy-related stroke can be achieved primarily through management of hypertension. Treatment of verified systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥110 mm Hg during pregnancy and within 6 weeks postpartum is recommended to reduce the risk of fatal maternal intracerebral hemorrhage. In addition, adverse pregnancy outcomes are common and are associated with chronic hypertension and an elevated stroke risk later in life. Therefore, screening for these pregnancy outcomes is recommended to evaluate for and manage vascular risk factors, and a screening tool is included to assist with screening in clinical practice.
9. Endometriosis, premature ovarian failure (before 40 years of age), and early-onset menopause (before 45 years of age) are all associated with an increased risk for stroke. Therefore, screening for all 3 of these conditions is a reasonable step in the evaluation and management of vascular risk factors in these individuals to reduce stroke risk.
10. Understanding transgender health is essential to truly inclusive clinical practice. Transgender women taking estrogens for gender affirmation have been identified as having an increased risk of stroke. Therefore, evaluation and modification of risk factors could be beneficial for stroke risk reduction in this population.”4
Additionally, most maternal strokes are “preventable with earlier and more aggressive blood pressure control,” according to the statement. The AHA’s 2025 high blood pressure guideline uses ACOG’s diagnostic criteria for hypertension in pregnancy defined as “systolic blood pressure (the top number) ≥140 mm Hg or diastolic blood pressure (the bottom number) ≥90 mm Hg,” per the AHA.2
“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,” added Miller.
The statement urges all clinicians who care for pregnant and postpartum patients to be trained to recognize stroke symptoms and initiate prompt evaluation. Neuroimaging modalities including computed tomography, computed tomography angiography and magnetic resonance imaging without contrast are considered safe for rapid assessment in pregnant patients with acute stroke symptoms.¹² Pregnancy alone should not delay recommended acute stroke treatments, including antithrombotic therapies and, when indicated, mechanical thrombectomy for large-vessel occlusions.1,2
Acute stroke is not an indication for immediate delivery if the mother is stable and the fetus is preterm. Vaginal delivery is preferred when feasible to avoid surgical risks and hemodynamic stress associated with cesarean delivery. Survivors of pregnancy-associated stroke often face unique challenges related to caring for an infant, breastfeeding, mood and sleep disturbances, and require coordinated support from a multidisciplinary rehabilitation team.
“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.2
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