Though stroke is not common in younger patients, the risk for it is higher in patients who are pregnant or postpartum. The teams at NewYork-Presbyterian's Comprehensive Stroke Centers, collaborating with the hospital's renowned ob-gyn and maternal-fetal medicine physicians, work to minimize the chance of a stroke for those at risk and have the expertise and knowledge to treat it promptly and effectively.
Call 9-1-1 immediately if you are experiencing any of these sudden stroke symptoms:
- Balance or coordination problems
- Loss of vision in one or both eyes
- One side of the face drooping or feeling numb
- Inability to lift both arms
- Slurred speech
Who is at Risk for Stroke During Pregnancy?
RiskAbout half of pregnancy-related strokes involve bleeding in the brain (hemorrhagic site), and the remainder are due to a blood clot (ischemic stroke). The risk of a stroke is most significant during the two weeks following childbirth and may remain elevated for 12 or more weeks after delivery.
A stroke in pregnancy is a rare event, but there are medical conditions that can increase the risk. Strokes happen in 30 out of every 100,000 deliveries and are most common (as high as 1 out of 500 births) in patients who develop preeclampsia — newly elevated blood pressure during pregnancy. Patients with these other risk factors may also be at higher risk for pregnancy-related stroke:
- Migraine headaches
- Vascular conditions
- Lupus
- Chronic kidney disease
- Hypertension (high blood pressure) diagnosed before pregnancy
- Gestational diabetes, which raises the risk of high blood pressure during pregnancy and for, heart disease, and stroke later in life
Contrary to popular belief, older age does not raise the risk of stroke during pregnancy. Columbia University researchers showed that stroke risk in older pregnant women is similar to women of the same age who aren't pregnant. However, one in five strokes in women under 35 was related to pregnancy.
If you are at high-risk for stroke, your doctor may recommend interventions during your pregnancy, such as taking a low dose of Aspirin.
How Pregnancy May Raise Stroke Risk
It is important for patients to understand the risks of a stroke during pregnancy. Changing hormones play a role, but there are other contributing factors. These include hypertensive pregnancy disorders and blood clotting disorders during pregnancy and postpartum.
Inflammation
Preeclampsia is characterized by inflammation, which can trigger a stroke. Columbia University researchers showed that patients with preeclampsia face a heightened risk of stroke during and after pregnancy if they have chronic high blood pressure, or clotting or bleeding disorders.
Stroke in patients with a history of hypertension in pregnancy is highest in the postpartum period if blood pressure is not optimally controlled. For this reason, it is essential to closely monitor blood pressure and provide treatment as needed.
Blood clots
Weill Cornell Medicine researchers reported that some patients remain at risk of developing a serious blood clot for 12 weeks after giving birth, particularly during the first six weeks following delivery. Pregnant patients’ blood is more likely to clot in order to prevent excessive blood loss during labor and childbirth. While the overall risk is low, those at risk of blood clots may take blood thinners during the postpartum period.
The recommendations for blood thinners during pregnancy and postpartum are individualized based on specific risk factors. For this reason, not all patients at risk for blood clots will take blood thinners.
Pregnancy and Postpartum Stroke Symptoms
SymptomsIf you are currently pregnant or have recently given birth, you'll want to familiarize yourself with the signs of a stroke, so you can seek immediate medical attention if they occur.
Stroke symptoms can include:
- Sudden numbness or weakness in the face, arms, or legs, particularly on one side of the body
- Dizziness and trouble walking
- Loss of vision in one or both eyes
- A sudden, severe headache that occurs out of nowhere
- Slurred speech or difficulty talking
Stroke symptoms after a Cesarean delivery
While postpartum strokes are rare, the risks of having one go up slightly if you've given birth by a Cesarean section. The Cesarean delivery procedure and the sedentary recovery time may increase the chance of blood clots. Be on the lookout for the warning signs: sudden numbness in the face, arms, or legs, dizziness, loss of vision, severe and sudden headache, and slurred speech.
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See a Stroke Specialist at NewYork-Presbyterian
Get CareThe obstetric and stroke care teams at NewYork-Presbyterian know how to recognize and manage pregnancy-related stroke and its risk factors. Our maternal-fetal medicine experts have cared for patients with the highest-risk, most complex pregnancies and can customize a plan of care to minimize the risk of stroke. If a stroke does occur, the neurologists and neuro-interventionalists in our Neuro-ICUs respond quickly and effectively to stabilize each patient and promote recovery. We even have dedicated neuro-obstetric teams which unite these specialists to achieve the best outcomes possible.
If you want help assessing your risk of a stroke during pregnancy, contact NewYork-Presbyterian today for an appointment.