Study Reveals Alarmingly High Missed Stroke Signs in Pregnant Women

More than 25% of pregnant or postpartum women who experienced an acute stroke had previously consulted health care providers for stroke-related symptoms but did not receive timely diagnoses. This finding comes from an analysis by the University of Pittsburgh School of Medicine, published in the journal Stroke. The results underscore a significant opportunity to enhance maternal health outcomes through improved clinician education and better decision-support tools.

“Stroke prevention is vital. We must close diagnostic gaps to protect maternal health,” stated Eliza Miller, M.D., the study’s senior author and associate professor of neurology at Pitt, as well as chief of women’s neurology at UPMC. She emphasized that early warning signs of strokes are frequently overlooked, particularly by clinicians lacking specialized neurology training. Miller is spearheading initiatives aimed at equipping healthcare professionals who treat pregnant and postpartum patients with the knowledge to recognize and respond to potential stroke indicators.

Stroke is a leading cause of maternal mortality and disability around the world, accounting for at least 1 in 12 maternal deaths. While strokes are relatively rare, the risk for pregnant women significantly increases in cases of preeclampsia, hypertension, and other factors. Symptoms of maternal strokes often present as vague and non-specific, such as severe headaches, neck pain, or confusion, which complicates timely diagnosis.

To investigate the prevalence of missed diagnostic opportunities, Miller and her team examined the cases of 135 women who suffered pregnancy-related strokes at five comprehensive stroke centers. The analysis revealed that 30% more patients who experienced missed diagnostic opportunities had consulted healthcare providers in the month leading up to their strokes compared to those whose strokes were diagnosed promptly. Notably, nearly half of those who sought medical attention prior to their strokes were evaluated by obstetricians, while about one-third were seen by emergency medicine clinicians.

“This represents a knowledge gap across specialties and highlights the need for expanded clinician education to recognize early signs of maternal stroke,” Miller noted. The research team, which included experts from maternal-fetal medicine, emergency medicine, and stroke neurology, advocates for the establishment of a multicenter patient registry for maternal stroke. Such a registry could facilitate better tracking of risk factors and outcomes, ultimately leading to enhanced decision-support tools that improve the ability of physicians to identify strokes in this unique patient population.

“At UPMC and the University of Pittsburgh, we are building one of the nation’s strongest maternal stroke programs,” Miller added. “Our commitment to innovation and cross-disciplinary collaboration ensures that every mother receives the vigilance and expertise she deserves, shaping a safer future for families everywhere.”

This research was partly funded by the Helen Gurley Brown Foundation and the Gerstner Family Foundation. The study’s co-authors include Noora Haghighi, M.S., Raeann Bourscheid, M.D., and Catherine Shang, M.D. from Columbia University; Elida Romo, Samantha Jankowski, Jane Holl, M.D., and Shyam Prabhakaran, M.D. from the University of Chicago; Farhan Khan, M.D. from Brown University; Alison Seitz, M.D. from the University of Washington; Sara Shapouran, M.D. from Montefiore Medical Center; Lauren Mamer, M.D., Ph.D., and William Meurer, M.D. from the University of Michigan; Ava Liberman, M.D. from Weill Cornell Medical Center; and Andrea Shields, M.D. from the University of Connecticut.

The study highlights an urgent need for improved education and awareness among healthcare providers to ensure timely diagnoses and better health outcomes for pregnant and postpartum women experiencing stroke symptoms.