A study of over 3,000 first-time mothers has found that women who experience pregnancy complications face significantly higher cardiovascular risk when combined with elevated stress levels, with effects persisting 2-7 years after delivery. Published in Hypertension, an American Heart Association journal, the research indicates that adverse pregnancy outcomes make women more susceptible to stress-driven blood pressure increases that could impact long-term heart health.
The study analyzed data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b), which included a racially, ethnically and geographically diverse population of 3,322 women ages 15-44. Researchers measured participants' blood pressure and stress levels during their first and third trimesters of pregnancy, and again 2-7 years after delivery. Adverse pregnancy outcomes included preeclampsia, preterm birth, small for gestational age birthweight, and stillbirth.
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. This association was not observed among women who did not experience pregnancy complications. "This suggests that women who had pregnancy complications may be more susceptible to the negative effects of stress on their heart health," said Virginia Nuckols, Ph.D., lead author of the study and a postdoctoral fellow at the University of Delaware.
The American Heart Association's 2025 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults emphasizes that high blood pressure during pregnancy can have lasting impacts on maternal health, including increased risk of preeclampsia, eclampsia, stroke, or kidney problems. The current study findings suggest that assessing and addressing stress may be an important additional strategy for reducing long-term cardiovascular risk for these women.
"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," Nuckols noted. "Although these blood pressure differences were modest (about 2 mm Hg), slight increases in blood pressure can affect heart disease risk over time." Women reporting moderate to high stress levels were typically younger (between 25 and 27 years of age), had higher body mass index, and lower educational attainment.
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 that stress levels were based on participants' own perceptions using the Perceived Stress Scale, and researchers were not able to characterize other components of the stress experience. Additionally, the study group only included women during their first pregnancy, and future research is needed to understand these links more comprehensively. The authors noted that 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 business and technology leaders in healthcare, these findings underscore the growing importance of integrated care models that address both physical and psychological factors in women's health. The research points to potential opportunities for digital health solutions, workplace wellness programs, and insurance coverage models that recognize stress management as a legitimate component of cardiovascular risk reduction. As healthcare systems increasingly focus on preventive care and long-term outcomes, understanding these connections between pregnancy complications, stress, and cardiovascular health could inform both clinical practice and health technology development.
