What is the clinical evidence from this study?

Study design: Cohort. Population: Pregnancy (n=220479). Intervention: Prior history of ischemic stroke vs. No prior history of ischemic stroke. Primary outcome: Incident ischemic stroke during pregnancy or ≤42 days postpartum (OR 2.37, 95% CI 1.97-2.87, p=<0.0001).

What question did this study set out to answer?

To assess recurrent ischemic stroke risk during pregnancy or postpartum in women with prior ischemic strokes.

January 16, 2026

Risk of Ischemic Stroke during Pregnancy and Post-partum Period in Women with a Prior History of Ischemic Stroke

Q: What are the key findings of this study?

A prior history of ischemic stroke significantly increased the risk of incident ischemic stroke during pregnancy or the early postpartum period (OR 2.37; 95% CI 1.97-2.87; p<0.0001).

Q: What does this research mean for the field?

Women with a prior history of ischemic stroke have 3.35 times higher odds of experiencing another ischemic stroke during pregnancy or postpartum period. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess recurrent ischemic stroke risk during pregnancy or postpartum in women with prior ischemic strokes.

Key Result

A prior history of ischemic stroke significantly increased the risk of incident ischemic stroke during pregnancy or the early postpartum period (OR 2.37; 95% CI 1.97-2.87; p<0.0001).

Key Points

To assess recurrent ischemic stroke risk during pregnancy or postpartum in women with prior ischemic strokes.
Conducted a retrospective cohort study using Oracle Health Real-World Data
Identified 220,479 completed pregnancies
Used ICD-10 codes for prior and incident ischemic strokes
Calculated odds ratios using multivariable logistic regression with propensity-score matching
34.82% of women with a prior stroke had an incident stroke during pregnancy
0.34% of women without a prior stroke experienced an incident stroke
Women with prior strokes had 2.37 times higher risk of ischemic stroke during pregnancy
Previous myocardial infarction and obesity were also significant risk factors for stroke

Study Design

Type

Cohort (n=220,479)

Structured PICO

Does a prior history of ischemic stroke increase the risk of incident ischemic stroke during pregnancy or the early postpartum period?

Population

220,479 completed pregnancies evaluated for the risk of incident ischemic stroke during pregnancy or within 6 weeks postpartum based on prior ischemic stroke history.

Exposure

Prior history of ischemic stroke

Comparator

No prior history of ischemic stroke

Outcome

Incident ischemic stroke during pregnancy or early post-partum period (within 6 weeks)hard clinical

Women with a prior history of ischemic stroke have a more than twofold higher odds of experiencing a recurrent ischemic stroke during pregnancy or the early postpartum period.

Main Result

Odds Ratio: 2.37 (95% CI 1.97–2.87)

Absolute Event Rate: 34.82% vs 0.34%

p-value: p=<0.0001

Abstract

Background: The risk of recurrent ischemic stroke during pregnancy or postpartum period in women with a history of ischemic stroke is unclear. Aims: To determine the risk of incident ischemic stroke during pregnancy or early post-partum period (within 6 weeks) among women with and without a prior history of ischemic stroke. Methods: We conducted a retrospective cohort study using Oracle Health Real-World Data (January 2015–February 2025). We identified 220,479 completed pregnancies; prior ischemic stroke by ICD-10-CM I69.3x/Z86.73; incident ischemic stroke by I63 during pregnancy or ≤42 days postpartum. Odds ratios (ORs) with 95% CIs were estimated using multivariable logistic regression after 1:10 propensity-score matching based on demographics and comorbidities. Results: The incident ischemic stroke rates were 415 out of 1,192 pregnancies (34.82%, 95% confidence interval CI: 32.16%–37.56%) among pregnant women with a prior history of ischemic stroke and 737 out of 219,287 pregnancies (0.34%, 95% CI 0.31%–0.36%) among pregnant women without a history of ischemic stroke. In the multivariate analysis, the risk of ischemic stroke during pregnancy or early postpartum period was significantly higher among pregnancies in women with a prior history of ischemic stroke compared with those in women without a history of ischemic stroke (OR 2.37, 95% CI 1.97–2.87, p < 0.0001). Previous myocardial infarction (OR 1.82, 95% CI 1.38–2.39, p < 0.0001) and obesity (OR 1.25, 95% CI 1.07–1.47, p < 0.01) were also associated with recurrent ischemic stroke during pregnancy or early postpartum period. The odds of experiencing an incident ischemic stroke among women with a prior history of ischemic stroke was significantly higher in women during pregnancy or early postpartum period compared with those with neither of the two conditions (OR 3.35, 95% CI 2.67–4.22, p < 0.0001). Conclusions: Women with a prior history of ischemic stroke had two times higher odds of having another ischemic stroke during pregnancy or postpartum period. Our findings have implications for counseling, surveillance, and enhanced recurrent stroke prevention in this high-risk group.

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