Increased Stress Due to Pregnancy Complications Raises Cardiovascular Risk, With Virginia Nuckols, PhD

Women who experience pregnancy complications such as preeclampsia, stillbirth, pre-term birth, or having a baby that is small for gestational age may have a greater risk for cardiovascular disease later in life, according to a recent study.1

The association between stress and cardiovascular disease is well documented. Given the dramatically increased psychosocial stress associated with pregnancy, a wealth of research exists surrounding its cardiovascular impact both immediately and later in life. The present study assessed whether psychosocial stress during and in the years after a first pregnancy was associated with blood pressure levels and hypertension risk.1

“We wanted to understand whether or not stress was at all related to the risk for cardiovascular disease and higher blood pressure in these women,” Virginia Nuckols, PhD, a postdoctoral fellow in the Department of Kinesiology and Applied Physiology at the University of Delaware and the lead author of the study, told HCPLive in an exclusive interview. “We found that women who had higher stress over time and had an adverse pregnancy outcome had higher blood pressure 2-7 years after delivery compared to women who have lower stress.”

Nuckols and colleagues utilized data from the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study (nuMoM2b-HHS) cohort. The team assessed perceived stress via the Perceived Stress Scale during the first and third trimester and 2-7 years post-delivery. Latent class trajectory analysis was used to characterize subgroups with similar patterns of perceived stress over time.2

Adverse pregnancy outcomes were abstracted from medical charts and ultimately included preterm birth, small-for-gestational-age, stillbirth, and hypertensive disorders of pregnancy. The team also used multivariable regression models to evaluate the independent effects of perceived stress on systolic and diastolic blood pressure, as well as incident hypertension 2-7 years after delivery.2

The records of 3322 first-time mothers were included in the study, with an age range of 15-44 years. All included patients did not have high blood pressure before pregnancy. When filling out the Perceived Stress Scale, all patients were asked to note how often they were in situations perceived as uncontrollable, unpredictable, and/or overwhelming in the previous month on a 5-point frequency scale, with higher scores indicating higher stress.1

Ultimately, Nuckols and colleagues found that higher stress levels over time in women with adverse pregnancy outcomes were associated with blood pressure roughly 2 mmHg higher than those with low stress; these results were maintained during the years 2-7 after delivery. However, this was not the case among women without adverse pregnancy outcomes. Additionally, patients who experienced moderate to high stress were often younger (25-27 years) and had higher body mass indices and lower educational attainment.1

Despite these results, the actual mechanism behind the association between increased stress and increased blood pressure in patients with pregnancy complications remains unclear. The investigators call on future research, suggesting examination of whether stress reduction interventions can meaningfully lower cardiovascular risk.1

“There is a lot more work to be done to understand effective and pragmatic interventions for this population of women who are experiencing novel stressors as they transition to motherhood,” Nuckols said. “We need to improve general awareness for clinicians that stress could play a role in cardiovascular risk, as well as communicating that to patients when they enter.”

Editors’ Note: Nuckols reports no relevant disclosures.

References

1. Beveridge K. Pregnancy complications impact women’s stress levels and cardiovascular risk long after delivery. Heart.org. March 9, 2026. Accessed March 26, 2026. https://newsroom.heart.org/news/pregnancy-complications-impact-womens-stress-levels-and-cardiovascular-risk-long-after-delivery

2. Nuckols VR, Barone Gibbs B, Brewer BC, et al. Stress trajectory and hypertension 2 to 7 years after delivery: A NUMOM2B-HHS Study. Hypertension. 2026;83(4). doi:10.1161/hypertensionaha.125.25991