Women who experience pregnancy complications such as pre-eclampsia, premature birth, stillbirth, or giving birth to a baby that is small for gestational age may face an increased risk of cardiovascular disease later in life. People who report high stress levels during and after pregnancy are at higher risk for high blood pressure, even years after giving birth, according to a new study published today in the American Heart Association journal Hypertension.
For women who had a baby for the first time and had complications called poor pregnancy outcomes, we found that increased stress levels over time were associated with higher blood pressure levels for two to seven years after giving birth. This suggests that women who have suffered pregnancy complications may be more susceptible to the negative effects of stress on heart health, and that taking steps to manage and reduce stress may be important to protect long-term heart health. ”
Dr. Virginia Nuckols, lead author of the study and postdoctoral fellow in the Department of Kinesiology and Applied Physiology at the University of Delaware
Stressful life events and perceived stress are associated with cardiovascular problems throughout women’s lives. Pregnancy is associated with amplified psychosocial stress, which may increase cardiovascular risk and increase the risk of adverse pregnancy outcomes and complications during pregnancy and/or childbirth. According to the American Heart Association, high blood pressure during pregnancy can have lasting effects on a mother’s health, and postpartum care is especially important to manage and reduce the risk of complications.
This study assessed whether psychosocial stress levels during a woman’s first pregnancy and in subsequent years were associated with maternal blood pressure levels and risk of developing hypertension. Additionally, we assessed whether certain complications during pregnancy and childbirth alter the relationship between stress levels and cardiovascular health.
Researchers measured mothers’ blood pressure and stress levels during the first and third trimester of pregnancy and two to seven years after giving birth.
The analysis revealed the following:
- Among women who experienced adverse pregnancy outcomes, high stress levels over time resulted in blood pressure 2 to 7 years postpartum that was 2 mmHg higher than blood pressure in the low stress group. However, this was not the case for women who did not experience adverse pregnancy outcomes.
- Those who experienced moderate to high levels of stress were younger (between 25 and 27 years), had a higher BMI, and had lower educational attainment.
- The results showed that women with adverse pregnancy outcomes may be more susceptible to the long-term negative effects of stress on heart health.
The authors noted that it is not clear exactly how increased stress leads to increased blood pressure in women with pregnancy complications, and several factors are likely at play. “Future research should investigate why women with a history of adverse pregnancy outcomes are more susceptible to stress-induced increases in blood pressure and test whether stress-reduction interventions can actually reduce cardiovascular risk in these women,” Dr. Nuckols said.
According to the American Heart Association’s 2025 Guidelines for the Prevention, Detection, Evaluation, and Management of Hypertension in Adults, high blood pressure during pregnancy can have lasting effects on maternal health, including preeclampsia, eclampsia, stroke, and kidney problems. Monitoring your blood pressure before, during and after pregnancy is very important to prevent and reduce the risk of long-term complications.
“Current guidelines emphasize blood pressure monitoring after adverse pregnancy events, and our findings suggest that assessing and managing stress may also be an important strategy to reduce long-term cardiovascular risk in these women,” Nuckolls said. “The differences in blood pressure observed in women who perceived higher stress levels were evident in women as young as 25 years old on average. Although these blood pressure differences were small (about 2 mm Hg), small increases in blood pressure can impact heart disease risk over time.”
“This study highlights the powerful connection between the heart and the heart and emphasizes the importance of stress management, especially for those who have experienced adverse pregnancy outcomes,” said Lakshmi Mehta, MD, FAHA, chair of the American Heart Association’s Council on Clinical Cardiology. “For clinical care teams, this re-emphasizes the need to proactively assess and manage stress as part of the comprehensive care they provide their patients. “Future research on the subject is equally important,” said Mehta, who was not involved in the study but is also the director of Preventive Cardiology and Women’s Cardiovascular Health, the Sarah Ross Souter Endowed Chair in Women’s Cardiovascular Health Research, and a professor of internal medicine at The Ohio State University Wexner Medical Center.
The study had some limitations, including that stress levels were based on participants’ own perceptions, so the researchers were unable to characterize other components of the stress experience, such as mood states or physical symptoms, which may have other effects on health. Additionally, perceived stress scores were not collected during participants’ second trimester, only during their first and third trimesters. Furthermore, specific individuals or combinations of adverse pregnancy outcomes (e.g., preeclampsia during pregnancy and delivery of a baby small for gestational age) can have distinct effects on stress trajectories and blood pressure. Additionally, this study group included only women in their first pregnancy. Future research is needed to understand the association between post-pregnancy stress and cardiovascular health.
Research details, background and design:
- Researchers analyzed records of 3,322 primiparous women aged 15 to 44 years (mean age 27 years) who did not have high blood pressure before pregnancy from the Nulliparous Pregnancy Outcomes Study: Monitoring Future Mothers (nuMoM2b), which included racially, ethnically, and geographically diverse populations. According to the authors, 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 had given birth to their first babies and were pregnant with only one baby.
- Researchers observed women during the first trimester and evaluated this information along with adverse pregnancy outcomes such as preeclampsia (new onset of high blood pressure during pregnancy), preterm birth, low birth weight for gestational age, and stillbirth.
- All participants completed the Perceived Stress Scale, a standard stress assessment questionnaire that measures how different situations affect emotions and perceived stress, using questions that rank individuals’ feelings and thoughts over the past month. Participants were assessed during the first and third trimester of pregnancy and between 2 and 7 years post-pregnancy. Subjects were asked to record how often in the past month they encountered situations that made them feel uncontrollable, unpredictable, or overwhelming, on a 5-point frequency scale, with higher scores indicating higher levels of perceived stress.
sauce:
american heart association
Reference magazines:
Knuckles, VR, others. (2026) Stress trajectories and hypertension 2–7 years postpartum: the nuMoM2b-HHS study. high blood pressure. DOI: 10.1161/HypertensionAHA.125.25991. https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25991
