A study published in Hypertension, an American Heart Association journal, has found that women who experience complications during their first pregnancy face persistently higher stress levels 2-to-7 years after delivery, which is associated with elevated blood pressure and increased cardiovascular disease risk. The research analyzed data from 3,322 first-time mothers and determined that women with adverse pregnancy outcomes may be more susceptible to the negative effects of stress on heart health.
According to lead author Virginia Nuckols, Ph.D., a postdoctoral fellow at the University of Delaware, higher stress levels over time were associated with blood pressure that was 2 mm Hg higher in women who experienced pregnancy complications compared to those with low stress levels. This association was not observed among women who did not experience adverse pregnancy outcomes. The blood pressure differences were apparent in young women averaging just 25 years of age, suggesting early intervention could be crucial.
The study examined women who experienced adverse pregnancy outcomes including preeclampsia, preterm birth, having a baby small for gestational age, or stillbirth. Researchers measured participants' stress levels using the Perceived Stress Scale during first and third trimesters and again 2-7 years after delivery. Women who reported moderate to high stress levels tended to be younger, have higher body mass index, and lower educational attainment.
The American Heart Association's 2025 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults emphasizes that high blood pressure during pregnancy can have lasting impacts on maternal health, including increased risk of stroke, kidney problems, and other cardiovascular complications. The current findings suggest that assessing and addressing stress may be an important additional strategy for reducing long-term cardiovascular risk in this population.
"This study highlights the powerful connection between the mind and heart, emphasizing the importance of stress management, particularly for those who have experienced adverse pregnancy outcomes," said Laxmi Mehta, M.D., FAHA, chair of the American Heart Association's Council on Clinical Cardiology. "For the clinical care team, it reinforces the need to proactively assess and address stress as part of the comprehensive care we provide to our patients."
Researchers noted several limitations, including that stress levels were based on participants' own perceptions rather than objective measures, and perceived stress scores were not collected during the second trimester. The study group only included women during their first pregnancy, and future research is needed to understand these relationships more completely. The authors suggest future studies should examine why women with a history of adverse pregnancy outcomes may be more susceptible to stress-driven increases in blood pressure and test whether stress reduction interventions can actually lower cardiovascular risk.
The study participants were enrolled at 17 medical centers across eight U.S. states as part of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b), which included a racially, ethnically and geographically diverse population. According to the authors, 66% of participants self-identified as white, 14% as Hispanic women, and 11% as Black women.
Although the blood pressure differences observed were modest at about 2 mm Hg, slight increases in blood pressure can affect heart disease risk over time. The findings emphasize the need for managing stress in women who have had adverse pregnancy outcomes, as they may face amplified cardiovascular risks that persist long after delivery. Monitoring blood pressure before, during and after pregnancy remains crucial to help prevent and reduce the risks of long-term complications.
