Adverse Childhood Experiences and Postcesarean Opioid Use: Does Labor Status Matter? [ID 985]

Adverse childhood experiences (ACEs) are associated with increased pain and opioid use after cesarean delivery (CD). Because prior trauma could affect pain perception related to labor, we examined the relationship between ACEs and postpartum opioid use stratified on presence of labor.

This was a prospective cohort study of postpartum people aged 18 years or older who underwent CD for a singleton pregnancy. Participants completed a validated ACE questionnaire 24-48 hours postpartum. Opioid use was measured as total opioid consumption throughout postpartum hospitalization, in oral milligram morphine equivalents (MMEs), divided by length of stay. We defined moderate-to-high opioid use as MME consumption in the 50th percentile or higher. Fisher's exact test and Spearman correlation coefficients evaluated the association between ACEs and opioid use, stratified by labor prior to CD.

Among 134 participants, 58% had an unlabored CD and 41% had a history of one or more ACEs. In unlabored CD only, one or more ACEs were associated with moderate-to-high opioid consumption (63% versus 38%, P=.04). Similarly, when evaluated continuously, ACEs were positively correlated with opioid consumption in unlabored CD (r=0.32, P=.01) but not labored CD (r=0.1, P =0.44).

Adverse childhood experiences were associated with increased opioid use in unlabored CD only. This contrasted with our hypothesis that people with trauma histories would be at greater risk of having re-emergence (manifesting as increased pain and opiate use) after a labored cesarean. Additional research is needed to understand the role of ACEs as an effect modifier in the relationship between labor and postcesarean pain.