TOPLINE:

Subsequent pregnancies in women with a prior maternal ischaemic stroke (IS) needed planning and close surveillance. Although most pregnancies proceeded without complications, a notable risk for diabetes, hypertensive disorders of pregnancy, and the recurrence of IS or transient ischaemic attack (TIA) was found.

METHODOLOGY:

• Researchers conducted a nationwide retrospective cohort study in Finland to assess the recurrence of IS or TIA and other maternal and neonatal complications during subsequent pregnancies among women with a history of IS.
• They included 90 women diagnosed with IS during pregnancy or the puerperium between 1987 and 2016; the control cohort comprised 265 pregnant women without a pregnancy-related stroke.
• The primary outcome was the recurrence of IS or TIA during subsequent pregnancies; secondary outcomes included maternal and neonatal complications and the use of secondary preventive medications during those pregnancies.

TAKEAWAY:

• Women with a history of maternal IS were less likely to have at least one subsequent pregnancy (adjusted odds ratio [aOR], 0.55; P = .026) and more likely to have multiple induced abortions (aOR, 6.24; P = .037) than control participants.
• Recurrent IS or TIA was reported in 8.6% of women during subsequent pregnancies, with recurrent IS reported in 5.7% and TIA reported in 2.9%.
• Women with a history of maternal IS were more likely to have diabetes (aOR, 2.77; P = .021) and hypertensive disorders of pregnancy (aOR, 3.57; P = .047) during subsequent pregnancies than those without a history of maternal IS.
• The use of antithrombotic medication among women with a prior maternal IS declined across pregnancies, from 87.9% in the first subsequent pregnancy to 66.7% in the third; 6-month postpartum continuation rates fell from 72.7% in the first subsequent pregnancy to 50.0% in the third.

IN PRACTICE:

"Maternal complications could likely be reduced through screening for HDPs [hypertensive disorders of pregnancy] and other stroke risk factors, regular follow-ups, and the initiation of appropriate secondary prevention. The use of antithrombotics should always be considered and, if indicated, continued for at least 6 weeks postpartum," the authors wrote.

SOURCE:

This study was led by Anna Richardt, MD, Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. It was published online on September 19, 2025, in Stroke.

LIMITATIONS:

This study was limited by the small cohort size due to the rarity of maternal ISs and the small size of the Finnish population. The study findings may have limited generalisability to other populations. Index pregnancies ending in induced or spontaneous abortion before 22 weeks were excluded, which may have underestimated the number of maternal IS cases.

DISCLOSURES:

This study received competitive state research funding for the responsibility area of the Helsinki and Uusimaa Hospital District and research funding from the Neurocenter of Helsinki University Hospital. One author reported receiving grants from Finska Läkaresällskapet, Sydäntutkimussäätiö, Tampere University Hospital, and Academy of Finland.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.