Pregnancy complications linked to higher early stroke risk

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The risk of stroke before the age of 50 years is increased in women with complications during pregnancy, according to a recent study published in Neurology, the journal of the American Academy of Neurology, on August 6, 2025.¹

Complications of pregnancy linked to increased stroke risk included preterm birth, gestational diabetes, preeclampsia, miscarriage, and stroke. Investigators noted that while this association was identified, the study did not prove that these complications are responsible for increased stroke risk among pregnant women.

“While the overall risk of stroke is still very low, our study found pregnancy complications may be an early warning sign of stroke risk—even before age 50,” said Frank-Erik De Leeuw, MD, PhD, study author from Radboud University. “Knowing this history could help doctors identify those who may benefit from early prevention and cardiovascular care.”

Early warning signs for stroke

Investigators assessed rates of pregnancy complications among patients with stroke vs those without stroke. Participants included women with at least 1 pregnancy, with 1 group including those reporting ischemic stroke when aged 18 to 49 years, while the other group did not experience stroke.

Preeclampsia was included as a complication, defined as high blood pressure during pregnancy. Preterm birth was defined as birth prior to 37 weeks’ gestation. Other complications included gestational diabetes and pregnancy loss, such as miscarriage and stillbirth.

One or more pregnancy complications were reported in significantly more patients with stroke vs those without stroke, at 51% vs 31%, respectively. A 2-fold increase in the odds of pregnancy complications was reported in patients with stroke following adjustments for maternal age at first pregnancy.

Stillbirth and preeclampsia showed strongest links

Participants with stillbirth had the most significant links for stroke, with a nearly 5-fold increase in risk. However, investigators noted a limited sample size of patients with stillbirth in the study population.

Additionally, the odds of stroke were increased approximately 4-fold in patients with preeclampsia and nearly 3-fold in those with preterm birth or small for gestational age birth. Preeclampsia and preterm birth were also linked to strokes caused by large artery disease, which is associated with a build-up of plaque in the arteries.

The study was limited by complication data being self-reported from participants rather than medical records. Additionally, adjustments were not made for certain stroke risk factors, such as cholesterol and high blood pressure.

“Our study suggests we may need to start thinking about cardiovascular prevention earlier in life—not just after menopause,” said De Leeuw. “Future studies should investigate the effects of lifestyle modification aimed at reducing cardiovascular risk in women with complications during pregnancy.”

Possible underlying mechanisms

While the study did not identify causes of stroke, investigators theorized that complications during pregnancy may indicate vulnerable blood vessels.² Additionally, the development of the placenta during pregnancy may be a source of atherosclerosis, increasing stroke risk.

Investigators recommended clinicians ask their patients about previous pregnancies when assessing stroke risk. While current guidelines recommend women with prior preeclampsia undergo cardiovascular disease screening once aged 50 years, Le Leeuw noted these findings indicate a need to begin screening sooner.

Approximately 1 in 5 individuals in high-income countries experience stroke. However, investigators noted that screening for stroke at an earlier age can be easily accomplished by measuring blood pressure once per year.

References

1. Complicated pregnancies linked to higher risk of early stroke. American Academy of Neurology. August 6, 2025. Accessed August 18, 2025. https://www.eurekalert.org/news-releases/1093620.
2. Higher risk of ischemic stroke at young age after pregnancy complications. Radboud University Medical Center. August 6, 2025. Accessed August 18, 2025. https://www.eurekalert.org/news-releases/1092404.