Preeclampsia is a leading pregnancy complication characterized by vascular dysfunction, leading to hypertension and organ damage. Evidence suggests positive associations between higher arterial stiffness and preeclampsia, as well as anxiety and preeclampsia. Anxiety, a transdiagnostic factor, is also associated with increased arterial stiffness in the general population, but no reports exist in pregnant women. Moreover, the association between anxiety and arterial stiffness in pregnancy and the risk of developing preeclampsia has not yet been explored. To address this gap, we aimed to evaluate the role of anxiety in arterial stiffness measurements and the development of preeclampsia in high-risk pregnant women. In this prospective study, women with high-risk singleton pregnancies before 14 weeks gestation were recruited at two tertiary care obstetric clinics in Montreal, Canada, and followed throughout pregnancy. Arterial stiffness parameters (carotid-femoral pulse wave velocity [cfPWV]) were measured at baseline (10-13 weeks gestation) and at four-week intervals throughout pregnancy. Self-reported anxiety symptoms were recorded using the Beck Anxiety Inventory, and participants’ scores were ranked as having minimal, mild, moderate, or severe anxiety. After excluding incomplete questionnaires, the total study sample comprised 156 women, of whom 10 (6.4%) developed preeclampsia. There was no difference in anxiety scores between groups based on baseline characteristics (i.e., age, BMI, and race). First trimester anxiety scores were associated with increased cfPWV in the early and late second trimester time points (p=0.02, p= 0.04, respectively). Higher baseline anxiety was also associated with a greater increase in cfPWV from baseline to 18 weeks gestation (p=0.04). A trend was also observed between baseline anxiety scores and the development of preeclampsia (p=0.07). Anxiety in the first trimester of pregnancy is associated with higher cfPWV values and a greater increase from the first to the second trimester, as well as potentially a higher risk for preeclampsia. Our ongoing study will further explore these findings as they can have important implications for patient prenatal care.