Pregnancy complications may signal early stroke risk

Experiencing complications during pregnancy is linked with a higher risk of stroke before age 50, according to a study published August 6, 2025, in Neurology^®, the medical journal of the American Academy of Neurology. Researchers found female participants who had certain pregnancy complications were more likely to have an early stroke. These included preeclampsia, preterm birth, gestational diabetes, miscarriage and stillbirth. The study does not prove that pregnancy complications cause stroke. It only shows an association.

While the overall risk of stroke is still very low, our study found pregnancy complications may be an early warning sign of stroke risk-even before age 50. Knowing this history could help doctors identify those who may benefit from early prevention and cardiovascular care."

 Frank-Erik De Leeuw, MD, PhD, study author of Radboud University in Nijmegen, the Netherlands

The study included 1,072 female participants who experienced at least one pregnancy, including 358 who had an ischemic stroke, ages 18 to 49 years old, and 714 without stroke.

Researchers looked at how often certain pregnancy complications occurred in those who had strokes compared to those who did not. They included preeclampsia, which is high blood pressure during pregnancy, preterm birth before 37 weeks, small-for-gestational-age births, gestational diabetes and pregnancy loss, including miscarriage and stillbirth.

The findings indicate that 51% of those who had a stroke experienced at least one pregnancy complication compared to 31% of those without a stroke. Once researchers adjusted for the age of the participants at the time of the first pregnancy, they found that people who had a stroke were more than twice as likely to have at least one pregnancy complication than people without a stroke.

The strongest associations were seen in participants with a history of stillbirth, who were nearly five times more likely to have a stroke, however De Leeuw noted that the number of participants who reported a stillbirth was small. Those with a history of preeclampsia were about four times more likely, while those with preterm birth or small-for-gestational-age births had nearly three times the risk.

Certain complications - especially preeclampsia and preterm birth - were associated with strokes caused by large artery disease, a type often linked to atherosclerosis, which is a build-up of fatty deposits called plaque in the arteries.

"Doctors should ask about pregnancy history when assessing stroke risk," De Leeuw said. "Our study suggests we may need to start thinking about cardiovascular prevention earlier in life-not just after menopause. Future studies should investigate the effects of lifestyle modification aimed at reducing cardiovascular risk in women with complications during pregnancy."

A limitation of the study is data on some pregnancy complications were reported by the participants themselves and may not be as reliable as medical records. Researchers were also unable to adjust for all stroke risk factors, like high blood pressure or cholesterol.