Stress Trajectory and Hypertension 2 to 7 Years After Delivery: A nuMoM2b-HHS Study

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.

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.

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).

These findings suggest that elevated perceived stress may contribute to higher blood pressure, specifically among women who had an APO.