Women who experience complications during their first pregnancy, such as preeclampsia, preterm birth, stillbirth, or delivering a baby small for gestational age, may face persistently higher stress levels that are linked to elevated blood pressure and increased cardiovascular risk years after delivery, according to new research published in Hypertension, an American Heart Association journal. The study of 3,322 first-time mothers found that among women who experienced adverse pregnancy outcomes, higher perceived stress levels over time were associated with blood pressure approximately 2 mm Hg higher than those with low stress levels during the 2-to-7 years following delivery. This association was not observed in women who did not experience pregnancy complications.
"For women who were having babies for the first time and had complications, referred to as adverse pregnancy outcomes, 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, and taking steps to manage and reduce stress could be important for protecting long-term heart health." Researchers measured participants' blood pressure and stress levels during their first and third trimesters of pregnancy, and again 2-7 years after delivery using the Perceived Stress Scale, a standard assessment questionnaire. The study population was racially, ethnically and geographically diverse, with participants enrolled at 17 medical centers across eight U.S. states.
Women who reported moderate to high stress levels were typically younger (between 25 and 27 years of age), had higher body mass index, and lower educational attainment. The findings indicate that women who experience adverse pregnancy outcomes may be particularly vulnerable to the long-term cardiovascular effects of stress. 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 have lasting impacts on maternal health, including increased risk of preeclampsia, eclampsia, stroke, or kidney problems. The guideline emphasizes blood pressure monitoring after adverse pregnancy events.
"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," said Nuckols. "The blood pressure differences we observed in women with higher perceived stress levels were apparent in young women only 25 years of age, on average. Although these blood pressure differences were modest, slight increases in blood pressure can affect heart disease risk over time." Dr. Laxmi Mehta, chair of the American Heart Association's Council on Clinical Cardiology, noted that "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." She added that for clinical care teams, the research reinforces the need to proactively assess and address stress as part of comprehensive patient care.
The study has limitations, including that stress levels were based on participants' self-perceptions, and researchers were unable to characterize other components of the stress experience. Additionally, perceived stress scores were not collected during the second trimester, and the study only included women during their first pregnancy. Future research is needed to understand the links between stress and cardiovascular health after adverse pregnancy outcomes and to test whether stress reduction interventions can lower cardiovascular risk for these women.
