Having a stroke as a young woman brings up many questions about the future, especially when it comes to having children. While planning a pregnancy after stroke requires extra care and attention, many women can safely have children with proper medical support and planning.

Understanding stroke risk in young women

You might be surprised to learn that strokes can affect young women. Kelly-Ann Patrice, MBBS, a vascular neurologist specializing in stroke care, explains that certain factors can increase a woman's stroke risk:

• Migraines with aura.
• Smoking, especially after age 40.
• Birth control pills containing estrogen.
• Pregnancy and the weeks following childbirth.

Why pregnancy affects stroke risk

Pregnancy naturally causes changes in your body that can increase stroke risk, including:

• Hormone changes.
• Increased chances of blood clotting.
• Hypertensive disorders of pregnancy.

For most women, these changes don't cause problems. However, if you've had a stroke before, your doctors will monitor these changes more carefully.

Planning for a safe pregnancy

"The main concern patients have is whether they would have another stroke during pregnancy and delivery," Dr. Patrice says. If you're thinking about having a baby after experiencing a stroke, here's what you should know:

Working with your health care team

You'll need support from several specialists working together:

• A stroke specialist (neurologist).
• An obstetrician (OBGYN).
• Your primary care physician.

"Having coordination between these three doctors helps ensure a safe pregnancy, delivery and postpartum period," Dr. Patrice says.

Understanding your risk

Your chance of having another stroke during pregnancy depends partially on what prompted your previous stroke and your current medical conditions. "We review the cause of prior strokes and current stroke risk factors to assess stroke risk in pregnancy so you can make an informed decision as to whether pregnancy is an option for you," explains Dr. Patrice. “We may also discuss with your OB-GYN the mode of delivery and whether it would be safe to proceed with a vaginal delivery, as opposed to a C-section."

Medication changes

Some common stroke prevention medicines aren't safe during pregnancy. Your doctor will help you:

• Stop certain medications before trying to conceive.
• Find safer alternatives during pregnancy.
• Decide if you need to continue taking aspirin (in some cases).

Fertility treatment

If you need fertility treatments, your doctors will carefully consider which options are safest for you. Some fertility medications contain hormones that might affect stroke risk, so your health care team will create a specialized plan.

Recognizing warning signs during pregnancy

Dr. Patrice emphasizes that stroke symptoms in young women can be different from what most people expect. First, it’s important to know these traditional signs of stroke, which follow the mnemonic BE FAST:

• Balance problems.
• Eye/vision changes.
• Face drooping.
• Arm weakness.
• Speech difficulty.
• Time to call emergency services.

There are other important warning signs that are more specific to young women:

• New or unusual headaches.
• Confusion or sudden behavioral change.
• Symptoms that seem different from normal pregnancy changes such as dizziness or severe nausea and vomiting.

The postpartum period

"The first six weeks after giving birth is also a time when you could be at increased risk of stroke," Dr. Patrice says. Stay in close contact with your doctor during this time, as your body is still adjusting to changes after pregnancy. Headaches during the postpartum period can be a warning sign of stroke.

Making informed decisions

When thinking about pregnancy after stroke, consider:

• Having a planned pregnancy so you can prepare properly.
• Getting advice from your health care team – including a neurologist, OBGYN and primary health physician – before trying to conceive.
• Understanding your options for delivery (vaginal birth or C-section).
• Creating a monitoring plan for during and after pregnancy.

There is hope

While planning a pregnancy after stroke requires extra care, many women can successfully have children with proper medical support. Dr. Patrice encourages patients to have open conversations with their health care providers about their reproductive goals and concerns.

Every situation is unique, and your team will work with you to create a personalized plan that prioritizes both your health and your dream of having a family.