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-as sociated (peripartum, ≤12 weeks postpartum) from later-life maternal stroke. PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, 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 sub type, stroke subtype, and effect measure; certainty was rated with Grading of Recommendations Assessment: Development and Evaluation (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 (PE/E) was associated with any stroke (hazard ratio [HR] 1.83, 95% confidence interval 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). PE/E was also associated with later-life ischemic stroke (HR 2.10, 1.50–2.93; k = 3). The only peripartum pooled cell was PE/E 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