Early Intervention for Postpartum PTSD: Comparing Written Exposure and Capnometry-Guided Breathing Therapy - PROJECT SUMMARY While childbirth is often viewed as a positive life event, up to one-third of women in the United States describe childbirth as traumatic. For those who experience severe maternal morbidity (SMM) or whose infants require neonatal intensive care unit (NICU) admission, the risk of traumatic childbirth developing into postpartum post- traumatic stress disorder (PTSD) is especially high, with prevalence estimates ranging from 16–20%. Postpartum PTSD is associated with significant adverse outcomes, including impaired maternal functioning, disrupted maternal-infant bonding, breastfeeding challenges, and long-term mental health morbidity. Despite growing awareness of these impacts, postpartum PTSD lacks standardized screening protocols and evidence- based early interventions that are scalable and suitable for busy perinatal care settings. This multi-site pilot study will assess the feasibility and acceptability of two innovative, low-burden, early interventions for postpartum PTSD: Written Exposure Therapy (WET) and Capnometry Guided Respiratory Intervention (CGRI). WET is a brief, 5-session trauma-focused psychosocial intervention using expressive writing, which has demonstrated non-inferiority to more intensive PTSD therapies. CGRI is an FDA-approved, home-based, digital breathing intervention designed to regulate physiological stress responses without requiring patients to process trauma content—an advantage for postpartum individuals who may prefer non-verbal, body-based therapies. Both interventions have shown efficacy in other populations but have not been tested in postpartum contexts. The study includes an initial adaptation and case series phase (n=10), followed by a randomized feasibility trial (n=60) in postpartum patients with clinically significant PTSD symptoms (PCL-5 score ≥28) within one month of a traumatic childbirth event. Participants will be randomized to WET, CGRI, or standard routine follow-up by nursing or social work (n=20 per group). Primary outcomes include feasibility of recruitment, intervention fidelity, patient adherence, and intervention acceptability using both quantitative measures and qualitative interviews. Secondary clinical outcomes include changes in PTSD symptom severity at 6 weeks and 3 months, as well as validated measures of maternal depression, anxiety, bonding, breastfeeding, and functional recovery. A novel exploratory aim will also assess the feasibility of collecting maternal hair samples during hospitalization and postpartum follow-up to measure a panel of corticosteroids (e.g., cortisol, cortisone, progesterone) using liquid chromatography-tandem mass spectrometry. These biomarkers will be evaluated in relation to PTSD symptom severity and treatment response, with the goal of informing future precision mental health strategies. This study will generate essential data to guide the development of a fully powered randomized controlled trial and support scalable, accessible early interventions for postpartum PTSD. This project aims to reduce suffering and enhance postpartum recovery outcomes in alignment with the NICHD’s mission to prevent maternal mental health disorders and promote lifelong health.
