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Pregnancy complications linked to ischemic stroke risk before age 50
Last reviewed: 09.08.2025
Pregnancy complications — preeclampsia, premature birth, gestational diabetes, miscarriage, or stillbirth — have long been suspected of being “beacons” of future cardiovascular problems. A new study published in Neurology shows that such episodes are associated with an increased risk of early ischemic stroke (before age 50). The link is particularly strong for strokes of the large artery type (atherosclerosis).
Research methods
The study included 1,072 women aged 18–49 years who had at least one pregnancy: 358 had experienced ischemic stroke, 714 did not. Pregnancy history was compared between the groups, taking into account complications: preeclampsia, preterm birth (<37 weeks), small for gestational age (SGA) babies, gestational diabetes, miscarriage and stillbirth. Age at first pregnancy was taken into account for interpretation; data were pooled from the ODYSSEY (young patients with stroke) and PRIDE (a national cohort of mothers and children in the Netherlands) cohorts. The design was a case-control comparison with calculation of associations.
Key Results
- Any pregnancy complication occurred in 51% of women with stroke versus 31% without stroke; after adjusting for age, women with stroke were >2 times more likely to have at least one pregnancy complication.
- Strongest connections:
- stillbirth - almost 5 times the risk of stroke (but few events),
- preeclampsia - ≈4-fold risk,
- Preterm birth or SGA - almost 3 times the risk.
- The link is particularly strong for strokes associated with large artery disease (atherosclerosis).
Interpretation and clinical conclusions
The authors consider pregnancy complications as an additional risk stratification tool: if there was, for example, preeclampsia or premature birth in the anamnesis, this is a reason to start prevention of cardiovascular diseases earlier - even before menopause. In practice, this means regular blood pressure measurement, lipid and glucose control, risk factor correction and informing patients about warning signs of stroke. It is important to remember that the study does not prove causality, but shows an association; some of the data on complications were self-reported, and not all factors (for example, hypertension outside pregnancy, cholesterol) could be fully taken into account.
Authors' comments
"The overall risk of stroke remains low, but pregnancy complications can serve as an early warning signal. Knowing this anamnesis helps to choose prevention and monitoring in time," said the study's leader Frank-Erik de Leeuw (Radboudumc). The Radboudumc press release also emphasizes that current recommendations for screening after preeclampsia often start around age 50, but these data support an earlier start of cardiac prevention in the risk group.