Pregnancy Complications Linked to Long-Term Stress & Heart Risk in Women

Women who experience complications during pregnancy – such as preeclampsia, preterm birth, or stillbirth – may face a heightened risk of cardiovascular issues, including high blood pressure, for years after delivery. New research, published today in Hypertension, underscores the importance of managing stress levels in these women, as higher stress appears to amplify that risk.

Heightened vulnerability after complicated pregnancies

The study, led by Virginia Nuckols, Ph.D., a postdoctoral fellow at the University of Delaware, found that women experiencing adverse pregnancy outcomes and reporting higher stress levels exhibited blood pressure readings approximately 2 mm Hg higher than those with low stress levels, two to seven years post-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,” Dr. Nuckols explained.

Pregnancy itself is a period of increased psychosocial stress, which can contribute to cardiovascular risks and adverse pregnancy outcomes. Research has shown a link between stress and cardiovascular health in women throughout their lives, and this new study builds on that understanding by focusing on the lasting impact of pregnancy-related stress.

How the study was conducted

Researchers followed over 3,000 women during their first pregnancies, assessing their stress levels and blood pressure during the first and third trimesters, and then again two to seven years after delivery. The goal was to determine if there was a correlation between psychosocial stress and the development of hypertension, and whether pregnancy complications altered that relationship. The study focused on first-time mothers carrying a single baby.

Key findings on stress and blood pressure

• Women with adverse pregnancy outcomes who reported higher stress levels had blood pressure 2 mm Hg higher than those with low stress levels, years after delivery. This difference was not observed in women without pregnancy complications.
• Participants experiencing moderate to high stress tended to be younger (between 25 and 27 years old), had a higher body mass index, and lower levels of educational attainment.
• The findings suggest that a history of adverse pregnancy outcomes may make women more vulnerable to the negative cardiovascular effects of stress.

Understanding the link: Preeclampsia and long-term cardiovascular health

Preeclampsia, a condition characterized by high blood pressure and potential organ dysfunction during pregnancy, is particularly relevant to this discussion. Studies demonstrate that women who experience preeclampsia have a significantly increased risk of developing cardiovascular disease later in life. The underlying mechanisms are complex, involving impaired placental development and the release of anti-angiogenic factors, as described in research published in Circulation Research. This highlights the importance of postpartum care and monitoring for cardiovascular risk factors in women with a history of preeclampsia.

Possible mechanisms and future research

The precise mechanisms linking higher stress to higher blood pressure in women with pregnancy complications remain unclear. Researchers hypothesize that multiple factors are likely involved. Dr. Nuckols suggests that future studies should investigate why these women may be more susceptible to stress-driven blood pressure increases and explore whether stress reduction interventions can effectively lower their cardiovascular risk.

Guideline context and clinical implications

The American Heart Association’s 2025 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults emphasizes the importance of blood pressure monitoring after adverse pregnancy events. These new findings reinforce that recommendation and suggest that assessing and addressing stress should also be a key component of comprehensive care for these women. Even modest increases in blood pressure, like the 2 mm Hg observed in the study, can contribute to 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.

Study limitations and unanswered questions

It’s important to note that the study relied on participants’ self-reported stress levels, which may not fully capture the complexity of their experiences. Researchers did not assess mood states or physical symptoms that could also impact health. Stress levels were only measured during the first and third trimesters, not the second. Further research is needed to understand how specific combinations of adverse pregnancy outcomes might affect stress trajectories and blood pressure.

This study focused solely on women during their first pregnancy. More research is needed to determine if these findings apply to subsequent pregnancies.

What comes next: Integrating stress management into postpartum care

The findings underscore the need for healthcare providers to proactively assess and address stress as part of routine postpartum care, particularly for women who have experienced pregnancy complications. This could involve screening for stress and anxiety, offering resources for stress management techniques (such as mindfulness or cognitive behavioral therapy), and providing support groups. Further research is needed to determine the most effective interventions for reducing stress and improving cardiovascular health in this population. The American Heart Association is likely to incorporate these findings into future guideline updates.

Journal information: Hypertension (2026). DOI: 10.1161/HYPERTENSIONAHA.125.25991