Pregnancy-Related Maternal Stroke Increasing Across US, With Mohammad Anadani, MD

Although rare, maternal stroke incidence rates are steadily increasing in the US, increasing the mortality risk to both mother and child, according to a recent retrospective analysis.1

Maternal stroke is notoriously understudied in recent years, with very limited data available since 2015. Prior studies have also included populations outside of the US, limiting the generalizability of results to US populations. Earlier studies have highlighted a rate of acute stroke of 45 per 100,000 hospitalizations – although this trend is not statistically significant, after transient ischemic attack (TIA) and unspecified codes were excluded, a substantial upward trend in incidence emerged.2

“When we look at the US compared to other countries, we have a higher incidence of maternal stroke, and that incidence is, unfortunately, not going down,” Mohammad Anadani, MD, chief of neuroendovascular services for Intent Medical Group at the Endeavor Health Advanced Neurosciences Center, told HCPLive in an exclusive interview. “If we look at just stroke incidence rate in general, it is actually going down. I was hoping, when we did the study, to see the same trend in maternal stroke, but we need to make a lot more effort to try and decrease that incidence.”

Anadani and colleagues conducted a retrospective analysis using data sourced from the Epic Cosmos database, a multicenter data set incorporating deidentified electronic health record data from >300 million patient records from >1800 academic and private hospitals, as well as 41,500 clinics across all 50 US states. All pregnancies resulting in live births between January 1, 2016, and January 1, 2024, were included in the study.1

Investigators defined maternal stroke as any inpatient encounter with a stroke-related diagnosis, including admission, discharge, or billing diagnosis, occurring from the start of pregnancy through 6 weeks postpartum. Stroke subtypes included ischemic stroke (IS), intracerebral hemorrhage, TIA, and subarachnoid hemorrhage.1

The primary study outcome was the incidence of maternal stroke, focusing on trends over time for both overall and specific subtypes. Secondary outcomes were divided into maternal and neonatal, with maternal including mortality, discharge destination, and complications during delivery admission, while neonatal outcomes involved the 5-minute Apgar score, length of hospital stay, incidence of fetal and neonatal demise, and birth weight.1

Ultimately, a total of 4,273,562 patients were enrolled in the study, accounting for 5,404,933 distinct pregnancies. Among these, 2637 were complicated by stroke. IS was the most common (52.6%), followed by hemorrhagic stroke (40.7% - 20% intracerebral and 20.7% subarachnoid). Investigators found that stroke was most frequent during the third trimester (51.3%) and the postpartum period (28.4%).1

The rate of stroke per 100,000 pregnancies was 48.8, not reaching statistical significance. However, analysis by stroke type indicated an upward trend in IS, while others remained relatively stable. Investigators analyzed age trends and saw a substantial increase in the average age of patients throughout the study period. Generally, patients with stroke were older (31.1 vs 29.8 years; P <.001), more likely to be Black (31.3% vs 18.9%), and more likely to be smokers (14.9% vs 8.6%; P <.001).1

Multivariable analysis highlighted several demographic and clinical factors independently associated with maternal stroke, including increasing maternal age (overall OR, 1.02; 95% CI, 1.01-1.03; ischemic OR, 1.02; 95% CI, 1.01-1.03; hemorrhagic OR, 1.05; 95% CI, 1.04-1.06). Congenital heart disease also showed strong association (overall OR, 5.74; 95% CI, 4.96-6.64), as did dyslipidemia (OR, 5.18; 95% CI, 4.54-5.91), atrial fibrillation (OR, 2.78; 95% CI, 2.21-3.5), heart failure (OR, 2.41; 95% CI, 1.91-3.03), and coronary artery disease (OR, 1.98; 95% CI, 1.52-2.58).1

Ultimately, investigators concluded that the disparity in maternal stroke rates between the US and other high-income countries may be due to differences in risk factor profiles or health care access. The team highlights the need for effective management strategies, including strengthening surveillance, addressing underlying risk factors, and promoting preventive care.1

“Recognition of stroke symptoms is very important, not only for the woman, but also the providers,” Anadani said. “So anything, any stroke-like symptoms like weakness, numbness, vision changes, speech difficulties, should be treated like stroke until proven otherwise.”

Editor’s Note: Anadani reports no relevant disclosures.

References

1. Anadani M, Hamoud L, Al Kasab S, et al. Pregnancy and Stroke: Insight From the Cosmos Database. Stroke. Published online February 2, 2026. doi:10.1161/STROKEAHA.125.054250

2. Elgendy IY, Gad MM, Mahmoud AN, Keeley EC, Pepine CJ. Acute Stroke During Pregnancy and Puerperium. J Am Coll Cardiol. 2020;75(2):180-190. doi:10.1016/j.jacc.2019.10.056