Abstract DP006: Two Folds Higher Odds of Ischemic Stroke during Pregnancy and Post-partum Period in Women with a History of Ischemic Stroke

Background: There is ambiguity regarding whether women with a history of previous ischemic stroke are at higher risk for recurrent ischemic stroke during pregnancy or in the post-partum period. We performed this study to determine the risk of ischemic stroke during pregnancy or in the post-partum period in women with a history of previous ischemic stroke. Methods: Using the Oracle Health Real-World Data, a de-identified large data source of multicenter electronic health records covering the period of January 2015 to February 2025, we determined the risk of new ischemic stroke during pregnancy or early post-partum period (within 6 weeks) among 220,479 pregnancies among women with and without previous history of ischemic stroke. Odds ratios (OR) were estimated with multivariable logistic regression after propensity-score adjustment for demographics, comorbidities, and relevant medications. White women and those aged 20–29 years were used as reference categories. Results: The incident event rates of new ischemic stroke were 415 out of 1,192 pregnancies (34.82%, 95% confidence interval [CI]: 32.16%–37.56%) among pregnant women with a history of ischemic stroke and 737 out of 219,287 pregnancies (0.34%, 95% CI 0.31%–0.36%) among pregnant women without a history of ischemic stroke. In the multivariate analysis, the risk of ischemic stroke during pregnancy or the early post-partum period was significantly higher among pregnancies in women with a history of ischemic stroke compared with those in women without a history of ischemic stroke (OR 2.37, 95% CI 1.97, 2.87, p < 0.0001). The risk of ischemic stroke during pregnancy or the early post-partum period were also significantly higher among pregnancies in women with previous myocardial infarction (OR 1.82, 95% CI 1.38, 2.39, p < 0.0001) and in women with obesity (OR 1.25, 95% CI 1.07, 1.47, p < 0.01). Conclusions: Women with a previous history of ischemic stroke had two times higher odds of having another ischemic stroke during pregnancy or post-partum period. Our findings have implications for counseling, surveillance, and enhanced recurrent stroke prevention in this high-risk group.