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Review Article
Online Published: 30 Aug 2026
 


Hypertensive disorders of pregnancy and the risk of pregnancy-associated stroke: a systematic review and meta-analysis by stroke subtype

Jihan Yousuf Maslamani, Yasser Ali Khoshaim, Obai T. Mesawa, Ahmed Azhar Anwar Alaqqad, Amal Anwar Alshaikh, Elaf Naif Alshaikh, Hala Sameer Sindi, Tala Kamil Tamim, Othman Mohammed O. Alamoudi, Manar Fahad Omar Alkhanbashi, Basem Muwaffaq Mufti, Alwaleed Khalid Shaher Alabdali.


Abstract
Hypertensive disorders of pregnancy (HDP) are among the most consistently reported risk factors for pregnancy-associated stroke, yet most prior syntheses pool all strokes together, obscuring subtype-specific associations. This review synthesized the HDP-stroke association, separating stroke subtypes and separating pregnancy-associated (peripartum, ≤12 weeks postpartum) from later-life maternal stroke. PubMed/MEDLINE, Embase, Cochrane CENTRAL, and Web of Science Core Collection were searched from inception to July 2026 without language or date restrictions. Cohort, case-control, and cross-sectional studies comparing HDP with normotensive women for a stroke outcome were eligible. Two reviewers independently screened, extracted, and rated risk of bias (Newcastle-Ottawa Scale). Adjusted estimates were pooled by random-effects meta-analysis (restricted maximum likelihood with Hartung-Knapp adjustment), separated by timing, HDP subtype, stroke subtype, and effect measure; certainty was rated with GRADE. Of 4,006 records identified and 2,630 screened, 58 studies were included, yielding 56 estimates across nine pooled cells. In later life, preeclampsia/eclampsia was associated with any stroke (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.36-2.48; k=6; I²=94%), as were gestational hypertension (HR 1.46, 1.27-1.69; k=4) and the any-HDP composite (HR 1.31, 1.22-1.42; k=4). Preeclampsia/eclampsia was also associated with later-life ischemic stroke (HR 2.10, 1.50-2.93; k=3). The only peripartum pooled cell was preeclampsia/eclampsia and intracerebral hemorrhage (odds ratio 9.17, 6.40-13.13; k=2). Certainty was low to very low. HDP was associated with increased stroke risk that differs by subtype and timing. Subtype- and timing-specific estimates, not a single pooled figure, should guide interpretation; future work should prioritize prospective, imaging-adjudicated peripartum cohorts with standardized HDP definitions.

Key words: Preeclampsia, hypertension, pregnancy-induced, stroke, intracerebral hemorrhage, cerebral venous thrombosis, meta-analysis


 
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How to Cite this Article
Pubmed Style

Maslamani JY, Khoshaim YA, Mesawa OT, Alaqqad AAA, Alshaikh AA, Alshaikh EN, Sindi HS, Tamim TK, Alamoudi OMO, Alkhanbashi MFO, Mufti BM, Alabdali AKS. Hypertensive disorders of pregnancy and the risk of pregnancy-associated stroke: a systematic review and meta-analysis by stroke subtype. IJMDC. Online First: 30 Aug, 2026. doi:10.24911/IJMDC.51-1783861441

Web Style

Maslamani JY, Khoshaim YA, Mesawa OT, Alaqqad AAA, Alshaikh AA, Alshaikh EN, Sindi HS, Tamim TK, Alamoudi OMO, Alkhanbashi MFO, Mufti BM, Alabdali AKS. Hypertensive disorders of pregnancy and the risk of pregnancy-associated stroke: a systematic review and meta-analysis by stroke subtype. https://www.ijmdc.com/?mno=327540 [Access: August 31, 2026]. doi:10.24911/IJMDC.51-1783861441

AMA (American Medical Association) Style

Maslamani JY, Khoshaim YA, Mesawa OT, Alaqqad AAA, Alshaikh AA, Alshaikh EN, Sindi HS, Tamim TK, Alamoudi OMO, Alkhanbashi MFO, Mufti BM, Alabdali AKS. Hypertensive disorders of pregnancy and the risk of pregnancy-associated stroke: a systematic review and meta-analysis by stroke subtype. IJMDC. Online First: 30 Aug, 2026. doi:10.24911/IJMDC.51-1783861441


Vancouver/ICMJE Style

Maslamani JY, Khoshaim YA, Mesawa OT, Alaqqad AAA, Alshaikh AA, Alshaikh EN, Sindi HS, Tamim TK, Alamoudi OMO, Alkhanbashi MFO, Mufti BM, Alabdali AKS. Hypertensive disorders of pregnancy and the risk of pregnancy-associated stroke: a systematic review and meta-analysis by stroke subtype. IJMDC, [cited August 31, 2026]; Online First: 30 Aug, 2026. doi:10.24911/IJMDC.51-1783861441


Harvard Style

Maslamani, J. Y., Khoshaim, . Y. A., Mesawa, . O. T., Alaqqad, . A. A. A., Alshaikh, . A. A., Alshaikh, . E. N., Sindi, . H. S., Tamim, . T. K., Alamoudi, . O. M. O., Alkhanbashi, . M. F. O., Mufti, . B. M. & Alabdali, . A. K. S. (2026) Hypertensive disorders of pregnancy and the risk of pregnancy-associated stroke: a systematic review and meta-analysis by stroke subtype. IJMDC, Online First: 30 Aug, 2026. doi:10.24911/IJMDC.51-1783861441


Turabian Style

Maslamani, Jihan Yousuf, Yasser Ali Khoshaim, Obai T. Mesawa, Ahmed Azhar Anwar Alaqqad, Amal Anwar Alshaikh, Elaf Naif Alshaikh, Hala Sameer Sindi, Tala Kamil Tamim, Othman Mohammed O. Alamoudi, Manar Fahad Omar Alkhanbashi, Basem Muwaffaq Mufti, and Alwaleed Khalid Shaher Alabdali. 2026. Hypertensive disorders of pregnancy and the risk of pregnancy-associated stroke: a systematic review and meta-analysis by stroke subtype. International Journal of Medicine in Developing Countries, Online First: 30 Aug, 2026. doi:10.24911/IJMDC.51-1783861441


Chicago Style

Maslamani, Jihan Yousuf, Yasser Ali Khoshaim, Obai T. Mesawa, Ahmed Azhar Anwar Alaqqad, Amal Anwar Alshaikh, Elaf Naif Alshaikh, Hala Sameer Sindi, Tala Kamil Tamim, Othman Mohammed O. Alamoudi, Manar Fahad Omar Alkhanbashi, Basem Muwaffaq Mufti, and Alwaleed Khalid Shaher Alabdali. "Hypertensive disorders of pregnancy and the risk of pregnancy-associated stroke: a systematic review and meta-analysis by stroke subtype." International Journal of Medicine in Developing Countries Online First: 30 Aug, 2026. doi:10.24911/IJMDC.51-1783861441


MLA (The Modern Language Association) Style

Maslamani, Jihan Yousuf, Yasser Ali Khoshaim, Obai T. Mesawa, Ahmed Azhar Anwar Alaqqad, Amal Anwar Alshaikh, Elaf Naif Alshaikh, Hala Sameer Sindi, Tala Kamil Tamim, Othman Mohammed O. Alamoudi, Manar Fahad Omar Alkhanbashi, Basem Muwaffaq Mufti, and Alwaleed Khalid Shaher Alabdali. "Hypertensive disorders of pregnancy and the risk of pregnancy-associated stroke: a systematic review and meta-analysis by stroke subtype." International Journal of Medicine in Developing Countries Online First: 30 Aug, 2026. Web. 31 Aug 2026 doi:10.24911/IJMDC.51-1783861441


APA (American Psychological Association) Style

Maslamani, J. Y., Khoshaim, . Y. A., Mesawa, . O. T., Alaqqad, . A. A. A., Alshaikh, . A. A., Alshaikh, . E. N., Sindi, . H. S., Tamim, . T. K., Alamoudi, . O. M. O., Alkhanbashi, . M. F. O., Mufti, . B. M. & Alabdali, . A. K. S. (2026) Hypertensive disorders of pregnancy and the risk of pregnancy-associated stroke: a systematic review and meta-analysis by stroke subtype. International Journal of Medicine in Developing Countries, Online First: 30 Aug, 2026. doi:10.24911/IJMDC.51-1783861441




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