# Preventing Maternal Mood, Anxiety, and Trauma Symptoms after Cesarean Delivery

> **NIH NIH R34** · UNIVERSITY OF COLORADO DENVER · 2024 · $157,500

## Abstract

PROJECT SUMMARY
Perinatal mental health disorders are the most prevalent perinatal comorbidity and are associated with the
primary cause of maternal mortality in the United States (US) – suicide. Diagnosis of a high-risk pregnancy and
cesarean delivery (CD) are both associated with increased risk for perinatal mood, anxiety, and trauma
symptoms (PMATS). There are over 1 million CDs annually in the US with one-third of these patients reporting
PMATS. Directing prevention efforts toward high-risk pregnant patients requiring CD addresses risk for PMATS
in a large patient population. There is a deficit in resources and access to mental health treatment for pregnant
patients, with some treatments being cost prohibitive and requiring multiple sessions. Additionally, current
approaches to addressing PMATS are reactive rather than preventive. There is evidence in the non-obstetric
population that single-session cognitive behavioral therapy interventions targeting anxiety sensitivity (fear of
fear) can prevent the development of anxiety and trauma symptoms when individuals are exposed to a trauma.
We developed a low cost, 1-hour, single-session prevention intervention that included psychoeducation about
anxiety sensitivity, coupled with a brief exposure to the operating room environment and CD procedures. We
previously tested this Brief Exposure intervention in the Operating Room (BE-OR) among a small group of
pregnant patients anticipating CD at a fetal care center and found a significant reduction in PMATS in the short
(1-4 weeks) and the long term (6-8 weeks). These results are incredibly promising, but scalability to a large
labor and delivery (L&D) unit with a more diverse patient population has not been established. To revise
implementation plan and BE-OR for use in large L&D units with a broader population of patients, a fully
powered multisite randomized control trial (RCT) is needed. Prior to initiating such a trial, Stage 1A/1B work
needs to be done to modify the intervention and implementation through a process of iterative refinement to
enhance acceptability, appropriateness, and feasibility of implementation in L&D units across the country, as
well as its efficacy at engaging with the target mechanism (anxiety sensitivity). Using a logic model to guide the
iterative refinement process through fast feedback loops and an atmosphere of co-creation, study investigators
will gather critical input from stakeholders (individuals with lived experiences, community partners, front-line
clinicians, hospital staff) via 12 workgroups, 12 user-testing design sessions, and repeated engagement with a
steering council. Following this refinement process, a treatment development pilot RCT (N=80) at a large L&D
unit will assess the efficacy of BE-OR by probing engagement with the target mechanism, as well as assess
feasibility of implementation. Finally, the updated logic model and pilot trial results will inform the development
of a protocol for a multisite RCT...

## Key facts

- **NIH application ID:** 10864511
- **Project number:** 1R34MH133685-01A1
- **Recipient organization:** UNIVERSITY OF COLORADO DENVER
- **Principal Investigator:** Allison Gail Dempsey
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $157,500
- **Award type:** 1
- **Project period:** 2024-05-03 → 2027-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10864511

## Citation

> US National Institutes of Health, RePORTER application 10864511, Preventing Maternal Mood, Anxiety, and Trauma Symptoms after Cesarean Delivery (1R34MH133685-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10864511. Licensed CC0.

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