Little is known about the pregnancy outcomes of women who have had a stroke prior to a first pregnancy.

To identify a cohort of primiparous women giving birth to a single baby and compare the pregnancy outcomes of those with a pre‐pregnancy stroke hospitalisation record to those without a stroke hospitalisation record.

Materials and Methods
Record linkage study of all primiparous women aged 15–44 years with singleton pregnancies birthing in New South Wales, Australia from 2003 to 2015. Stroke was identified from 2001 to 2015 hospital data using International Classification of Diseases tenth Edition – Australian Modification codes I60–64. Women whose first hospital record of stroke was during pregnancy or <42 days after birth were excluded. Outcomes included diabetes or hypertension during pregnancy, mode of delivery, haemorrhage, severe maternal morbidity (validated composite outcome indicator), gestational age at birth, Apgar score (1 min < 7), and small‐for‐gestational age. Results Of 487 767 women with a first pregnancy, 124 (2.5/10 000) had a hospital record which included a pre‐pregnancy stroke diagnosis. Women with a stroke history were more likely to have an early‐term delivery (37–38 weeks; relative risk (RR) 1.49, 95% CI 1.17–1.90) and a pre‐labour caesarean (RR 2.83, 95% CI 2.20–3.63). There were no significant differences in other maternal or neonatal outcomes. Conclusion This is the largest reported study of pregnancy and birth outcomes for women with a history of stroke. With the exception of pre‐labour caesarean, there were no differences in pregnancy outcomes for women with a history of stroke compared with women with no history of stroke.