Key result
Higher stress linked to ~2 mmHg greater postpartum DBP after adverse pregnancy outcomes.
Why the study?
Adverse pregnancy outcomes are associated with higher risk of chronic hypertension, but the role of perceived stress patterns during and after pregnancy on later blood pressure and hypertension is unclear.
Does the trajectory of perceived psychosocial stress during and after pregnancy affect blood pressure and incident hypertension 2 to 7 years postpartum, and is this modified by a history of adverse pregnancy outcomes?
Cohort (n=3,322)
Yes
Does the trajectory of perceived psychosocial stress during and after pregnancy affect blood pressure and incident hypertension 2 to 7 years postpartum, and is this modified by a history of adverse pregnancy outcomes?
Elevated perceived psychosocial stress over time is associated with higher postpartum blood pressure only among women with a history of adverse pregnancy outcomes, highlighting a vulnerable subgroup for targeted cardiovascular monitoring.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“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.”
“There is some data that has come out in the last few years that linked a history of adverse pregnancy outcomes to stress in women, and we know that stress is also related to cardiovascular risk. So we wanted to see if stress experienced during and after pregnancy was a factor in cardiovascular risk in women. This is the first study to put those pieces together.”
“The current guideline emphasizes blood pressure monitoring and management 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. 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.”
Supports targeted stress assessment in women with prior APOs; leaves open whether interventions modify postpartum BP risk.
BACKGROUND: Adverse pregnancy outcomes (APOs) are associated with a higher risk of developing chronic hypertension. The objectives of this study were to determine whether patterns of perceived stress during and after pregnancy were associated with blood pressure and incident hypertension 2 to 7 years after delivery, and whether having an APO modified this association. METHODS: Analyses utilized data from the prospective nuMoM2b-HHS cohort (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study). Perceived stress was assessed using the Perceived Stress Scale in the first and third trimester and 2 to 7 years after delivery. Latent class trajectory analysis characterized subgroups with similar patterns of perceived stress over time. APOs were abstracted from medical charts and included hypertensive disorders of pregnancy, preterm birth, small-for-gestational-age, and stillbirth. Multivariable regression models evaluated the independent effects of perceived stress on systolic and diastolic blood pressure and incident hypertension and 2 to 7 years after delivery. RESULTS: Three distinct stress trajectory groups emerged, delineated by persistently low, moderate, and high stress levels. No associations between stress trajectory group and blood pressure or incident hypertension were observed after adjustment for covariates. However, there was a significant interaction between stress trajectory group and APO on blood pressure ( P for interaction=0.04). Stress trajectory group was associated with higher blood pressure only among those with APO ( β =1.991±0.819 mm Hg; P =0.02) but not without APO ( β =0.040±0.471 mm Hg, P =0.93). CONCLUSIONS: These findings suggest that elevated perceived stress may contribute to higher blood pressure, specifically among women who had an APO.
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Nuckols et al. (2026) conducted a cohort in Pregnancy and Postpartum Health (n=3,322). Perceived psychosocial stress vs. Low stress trajectory group was evaluated on Diastolic blood pressure 2 to 7 years after delivery in women with an adverse pregnancy outcome (β = 1.991, p=0.02).
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