Women who experience complications during their first pregnancy may face increased cardiovascular risk years after delivery, particularly when combined with persistent stress, 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 who reported higher stress levels had blood pressure approximately 2 mm Hg higher than their low-stress counterparts 2-7 years after delivery.
"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."
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. Adverse pregnancy outcomes included conditions like preeclampsia, preterm birth, small for gestational age birthweight, and stillbirth.
Participants completed the Perceived Stress Scale during their first and third trimesters and again 2-7 years postpartum. The assessment measures how often individuals feel situations are uncontrollable, unpredictable or overwhelming. Women with moderate to high stress levels tended to be younger (25-27 years), have higher body mass index, and lower educational attainment.
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 stroke, kidney problems, and other cardiovascular complications.
"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 blood pressure differences we observed in women with higher perceived stress levels were apparent in young women only 25 years of age, on average."
While the 2 mm Hg difference may seem modest, researchers note that even slight increases in blood pressure can affect heart disease risk over time. The study's authors emphasize that the exact mechanisms linking stress to higher blood pressure in women with pregnancy complications remain unclear and require further investigation.
"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."
The research has limitations, including reliance on self-reported stress measures and lack of data from the second trimester. Additionally, the study only included first-time mothers, and researchers note that specific combinations of adverse pregnancy outcomes may have distinct effects on stress and blood pressure.
Future studies should examine why women with adverse pregnancy outcomes may be more susceptible to stress-driven blood pressure increases and test whether stress reduction interventions can lower cardiovascular risk. The findings underscore the importance of integrated postpartum care that addresses both physical and psychological factors in women's long-term cardiovascular health.
