Women who experience complications during their first pregnancy may face increased cardiovascular risks years after delivery, particularly if they report high stress levels, according to new research published in Hypertension, an American Heart Association journal. The study of over 3,000 first-time mothers found that those with adverse pregnancy outcomes showed blood pressure readings approximately 2 mm Hg higher than women with low stress levels when measured 2-to-7 years after delivery.
The research analyzed data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b), which included a racially, ethnically and geographically diverse population across 17 U.S. medical centers. Participants completed the Perceived Stress Scale during their first and third trimesters and again 2-7 years postpartum, with higher scores indicating greater perceived stress. Adverse pregnancy outcomes included conditions like preeclampsia, preterm birth, having a baby small for gestational age, or stillbirth.
"For women who were having babies for the first time and had complications, we found that higher stress levels over time were associated with higher blood pressure levels 2-to-7 years after delivery," said Virginia Nuckols, Ph.D., lead author of the study and a postdoctoral fellow at the University of Delaware. "This suggests that women who had pregnancy complications may be more susceptible to the negative effects of stress on their heart health."
The findings are particularly significant because the blood pressure differences were observed in relatively young women, with an average age of 25-27 years among those reporting moderate to high stress levels. While a 2 mm Hg increase may seem modest, even slight elevations in blood pressure can accumulate over time to significantly impact cardiovascular disease risk. According to the American Heart Association's 2025 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults, high blood pressure during pregnancy can lead to lasting health consequences including stroke, kidney problems, and other cardiovascular complications.
Researchers noted that women experiencing moderate to high stress levels tended to be younger, have higher body mass index, and lower educational attainment. The study did not find the same association between stress and blood pressure in women who did not experience pregnancy complications, suggesting that adverse pregnancy outcomes may create a unique vulnerability to stress-related cardiovascular effects.
"The current guideline emphasizes blood pressure monitoring after an adverse pregnancy event, and our findings suggest that assessing and addressing stress may also be an important strategy for reducing long-term cardiovascular risk for these women," Nuckols explained. The study authors called for future research to examine why women with pregnancy complications might be more susceptible to stress-driven blood pressure increases and to test whether stress reduction interventions could lower cardiovascular risk.
Laxmi Mehta, M.D., FAHA, chair of the American Heart Association's Council on Clinical Cardiology, emphasized the clinical implications: "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. 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."
The study has limitations, including reliance on self-reported stress measures and lack of data collection during the second trimester. Researchers also noted that specific combinations of adverse pregnancy outcomes might have distinct effects on stress and blood pressure that require further investigation. However, the findings underscore the importance of considering both physical and psychological factors in postpartum care for women who have experienced pregnancy complications.
