Pregnancy complications increase heart health risks for women with high stress

Women who experience pregnancy complications, like preeclampsia, pre-term birth, stillbirth or having a baby that is small for gestational age, may face an increased risk for cardiovascular disease later in life. For those who report high stress levels during and after pregnancy, there is a more elevated risk for high blood pressure, even years after they deliver, according to new research published today in Hypertension, an American Heart Association journal.

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. 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.”

Virginia Nuckols, Ph.D., lead author of the study and postdoctoral fellow in the University of Delaware’s Department of Kinesiology and Applied Physiology

Stressful life events and perceived stress are associated with cardiovascular issues in women over the course of their lives. Pregnancy is associated with amplified psychosocial stress, which can lead to higher cardiovascular risks and increase the risk of adverse pregnancy outcomes, or complications during pregnancy and/or delivery. According to the American Heart Association, high blood pressure during pregnancy can have lasting effects on the mother’s health and postpartum care is especially important to manage and mitigate risk of complications.

This study assessed whether psychosocial stress levels during a woman’s first pregnancy and in the years after are linked to the mother’s blood pressure levels and risk of developing hypertension. Additionally, it evaluated if certain complications during pregnancy and delivery change the relationship between stress levels and cardiovascular health.

Researchers measured the mothers’ blood pressure and stress levels during their first and third trimesters of pregnancy, and again 2-7 years after delivery.

The analysis found:

• Among women who experienced adverse pregnancy outcomes, higher stress levels over time were associated with blood pressure that was 2 mm Hg higher than that of the low stress group during the years 2-7 years after delivery; however, this was not the case among women who did not experience adverse pregnancy outcomes.
• Those who experienced moderate to high stress levels were often younger (between 25 and 27 years of age), had higher body mass index and lower educational attainment.
• Results showed that women who had adverse pregnancy outcomes may be more susceptible to the long-term negative effects of stress on their heart health.

The authors noted that it’s not clear exactly how higher stress leads to higher blood pressure in women who had pregnancy complications, and there are likely several factors involved. “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 for these women,” said Dr. Nuckols.

High blood pressure during pregnancy can have lasting impacts on maternal health, such as preeclampsia, eclampsia, stroke or kidney problems, according to the American Heart Association’s 2025 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. Monitoring blood pressure before, during and after pregnancy is crucial to help prevent and reduce the risks of long-term 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,” 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 (about 2 mm Hg), slight increases in blood pressure can affect heart disease risk over time.”

“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. Future research on whether targeted interventions to reduce or manage stress has a meaningful impact on long-term cardiovascular outcomes will be important as well.” Mehta, who was not involved in the study, is also the director of preventative cardiology & women’s cardiovascular health, the Sarah Ross Soter Endowed Chair in Women’s Cardiovascular Health Research and professor of internal medicine at The Ohio State University Wexner Medical Center.

The study has some limitations, including that stress levels were based on participants’ own perceptions, therefore, researchers were not able to characterize other components of the stress experience, including mood states or physical symptoms, which may have other impacts on health. Also, perceived stress scores were not collected during the participants’ second trimester, only during the first and third trimesters. Additionally, it is possible that specific individual or combinations of adverse pregnancy outcomes (for example, preeclampsia during pregnancy along with having a baby that is small for gestational age) may have distinct effects on stress trajectory or blood pressure. Further, this study group only included women during their first pregnancy. Future research is needed to understand the links between stress and cardiovascular health after an adverse pregnancy outcome.

Study details, background and design:

• Researchers analyzed records of 3,322 first-time mothers, ages 15-44 (average age of 27) who did not have high blood pressure before pregnancy, from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b), which included a racially, ethnically and geographically diverse population. According to the author, 66% of participants self-identified as white, 14% self-identified as Hispanic women, and 11% self-identified as Black women.
• Study participants were enrolled at 17 medical centers in eight U.S. states. The women were having their first child and pregnant with only one baby.
• Researchers observed women in their first trimester and evaluated this information with adverse pregnancy outcomes, which included preeclampsia (new-onset high blood pressure during pregnancy), preterm birth, small for gestational age birthweight and stillbirth.
• All participants completed the Perceived Stress Scale, a standard stress assessment questionnaire that measures how different situations affect feelings and perceived stress, using questions that rank a person’s feelings and thoughts during the last month. Participants took the assessment during the first and third trimester of pregnancy, as well as 2-7 years after pregnancy. They were asked to note how often they were in situations they perceived as uncontrollable, unpredictable or overwhelming in the previous month on a five-point frequency scale, with a higher score indicating higher levels of perceived stress.