A nationwide Finnish cohort study evaluated long-term mortality, morbidity, recovery, and stroke recurrence following maternal ischemic stroke. The findings showed a significantly higher risk of mortality after pregnancy-related stroke, especially within the first year. Affected women also had an increased risk of subsequent morbidities. However, despite these risks, functional recovery was generally favorable in both the short- and long-term follow-up. The study was published in the journal Neurology by Anna R. and colleagues.
Maternal ischemic stroke (IS) represents a serious, yet unusual, pregnancy complication, while emerging evidence now also reveals that its intercurrent health outcomes extend well beyond this event itself. The current study analyzed a group of women diagnosed with ischemic stroke in Finland from 1987 through 2016 from a nationwide population, while this diagnosis was verified from individual healthcare records. The population of controls consisted of three pregnant women, each from a group of women experiencing ischemic stroke, while matching was based upon delivery year, age, and geographical location. Mortality outcomes were ascertained through 2022 from the national Causes of Death Register, while cardiovascular outcomes, depression, and vocational outcomes were ascertained from a hospital and employment registry, respectively.
Key findings
Overall, 97 women had maternal ischemic stroke, and among them, 92 survived for at least one year following the index event.
They were matched to controls consisting of 265 subjects.
There was no significant difference in the median age at delivery between the two groups, which was 30.6 years for both groups.
They had median follow-up times as high as 17.4 years to ascertain survival and 11.6 years to determine their subsequent morbidity and vocational status.
Overall mortality was higher in maternal IS patients than in controls (8.3% vs 1.8%), with an age-adjusted odds ratio (aOR) of 4.96 (95% CI, 1.58–15.60).
Mortality differences were most pronounced within the first year after stroke and were no longer statistically significant thereafter.
Recurrent ischemic stroke occurred in 5 women (5.6%) with maternal IS.
Major cardiovascular events were more frequent in maternal IS patients (6.7% vs 0%; p < 0.001). Cardiac disease risk was markedly increased (aOR 8.57; 95% CI, 2.22–33.08).
Depression was significantly more common among maternal IS survivors (aOR 3.92; 95% CI, 1.86–8.24).
Among survivors at the end of follow-up, 92.1% achieved good functional outcomes, defined as modified Rankin Scale scores of 0–2.
Despite good functional recovery, employment was less frequent (aOR 0.55; 95% CI, 0.32–0.94), while retirement was substantially more common (aOR 4.55; 95% CI, 2.03–10.17) in maternal IS patients compared with controls.
This nationwide longitudinal study shows that maternal ischemic stroke is associated with high mortality, significant cardiovascular and psychiatric morbidity, and lower workforce participation despite good functional neurological outcomes in the majority of survivors. Optimizing prognosis in these young women requires lifelong cardiovascular prevention strategies and comprehensive rehabilitation due to the lasting clinical and socioeconomic consequences of maternal stroke.
Reference:
Richardt, A., Verho, L., Rantanen, K. K., Korhonen, A., Laivuori, H., Tikkanen, M., Gissler, M., Aarnio, K., & Ijäs, P. H. (2026). Long-term recovery, morbidity, and mortality after maternal ischemic stroke. Neurology, 106(4), e214619. https://doi.org/10.1212/WNL.0000000000214619
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