JMIR Publications

ABSTRACT

Background:

Pregnancy- or childbirth-related traumatic experiences may lead to posttraumatic stress disorder (PTSD) symptoms during the postpartum period, adversely affecting women and their families. Digital health interventions may improve access to psychological support; however, evidence of their effectiveness for pregnancy- and childbirth-related posttraumatic stress disorder (PCR-PTSD) symptoms remains limited and has not been systematically synthesized.

Objective:

This review aimed to evaluate the effects of digital health interventions on PCR-PTSD symptoms in postpartum women, with depressive and anxiety symptoms as secondary outcomes.

Methods:

We searched 7 English-language and 4 Chinese-language databases from inception through April 30, 2026, to identify randomized controlled trials (RCTs) evaluating digital health interventions in women who had experienced pregnancy- or childbirth-related traumatic events and were assessed for PTSD symptoms during the postpartum period. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Effect estimates were pooled using random-effects models with restricted maximum likelihood estimation and Hartung-Knapp adjustments and reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Statistical heterogeneity, 95% prediction intervals (PIs), subgroup effects, and the robustness of pooled estimates were also examined.

Results:

A total of 10 RCTs involving 1026 participants were included. Of these, 9 trials (809 participants) reported PTSD symptom outcomes immediately after the intervention, and 6 trials (413 participants) reported outcomes at follow-up. Digital health interventions were associated with lower PTSD symptom severity immediately after the intervention (SMD −0.59, 95% CI −0.98 to −0.19, 95% PI −1.72 to 0.54; P=.01), with substantial heterogeneity (I²=79.86%). However, the pooled effect was not statistically significant at the longest available follow-up (SMD −0.36, 95% CI −1.00 to 0.27, 95% PI −2.03 to 1.31; P=.20). All 95% PIs crossed the null. No statistically significant subgroup differences were observed by PTSD-related eligibility requirements, delivery modality, intervention duration, or trauma context. A statistically significant subgroup difference was observed by healthcare provider involvement (Q=14.46, P<.001); however, this exploratory finding should be interpreted cautiously. Sensitivity analyses supported the robustness of the pooled effect on PTSD symptoms immediately after the intervention.

Conclusions:

Digital health interventions may be associated with short-term reductions in PTSD, depressive, and anxiety symptoms among women with pregnancy- or childbirth-related trauma. However, substantial heterogeneity and prediction intervals crossing the null limit confidence in these effects. Further well-designed trials with clinically interpretable outcomes and longer follow-up are needed. Clinical Trial: PROSPERO CRD420261290528; https://www.crd.york.ac.uk/PROSPERO/view/CRD420261290528