Infant neonatal intensive care unit (NICU) hospitalization increases maternal risk for post-traumatic stress disorder (PTSD) symptoms, which may negatively impact mother-child attachment and infant growth and development. Prior studies have documented positive associations between unmet parenting expectations and adverse maternal psychological outcomes, including post-NICU discharge. However, no studies have yet explored how unmet parenting expectations may be associated with maternal NICU-related PTSD symptoms. The current paper reports a focused analysis of cross-sectional questionnaire data collected from NICU mothers (n = 128) during a larger mixed methods study. Multiple linear regression was used to test the association between parenting expectation-experience differences (EEDs) and NICU-related PTSD symptoms reported by mothers 1-5 years post-infant NICU hospitalization. The moderating role of parenting self-efficacy was also examined. After adjusting for covariates in the main effects model, a negative association was found between EED scores and NICU-related PTSD symptoms (B = -1.5, p 0.001), and perceived parenting self-efficacy was found to moderate (weaken) this negative association. Findings suggest that interventions and NICU care practices aimed at better aligning parenting expectations and NICU experiences and at promoting parenting self-efficacy among NICU mothers may strengthen delivery of supportive, family-centered care and may lead to improved maternal and child outcomes in this population.