Pregnancy and Stroke Risk

OBJECTIVE: This article reviews the epidemiology, pathophysiology, clinical management, and prevention strategies for pregnancy-related stroke, with a focus on recognizing risk factors, guiding acute treatment, and counseling for future pregnancies. LATEST DEVELOPMENTS: Recent data highlight rising rates of pregnancy-related strokes, particularly among older maternal age groups, with increasing contributions from ischemic strokes and cerebral venous thrombosis. Advances in imaging safety, thrombolysis, and endovascular therapy now support their use in selected pregnant and postpartum patients. Low-dose aspirin, tighter blood pressure control, and preconception counseling have emerged as key strategies for stroke prevention, especially in women with hypertensive disorders of pregnancy or thrombophilia. ESSENTIAL POINTS: Stroke affects approximately 30 per 100,000 pregnancies, with risk peaking in the peripartum and postpartum periods. Physiologic changes during pregnancy, including hypercoagulability, venous stasis, and vascular injury, contribute to increased risk. Acute stroke therapies, including thrombolysis and endovascular thrombectomy, can be used safely in pregnant patients. Prevention efforts should focus on optimizing blood pressure, screening for thrombophilia, encouraging healthy lifestyle behaviors, and using low-dose aspirin in women at high risk.