Adverse childhood experiences and post-cesarean pain and in-hospital opioid use: a prospective cohort study

Adverse childhood experiences (ACEs) are linked to higher opioid use and pain in non-pregnant populations, yet their effect after cesarean delivery is unclear. We evaluated whether ACEs influence postpartum opioid use and pain following cesarean.

We prospectively enrolled English or Spanish speaking women undergoing scheduled or intrapartum cesarean delivery under neuraxial anesthesia (2023-2024).The exposure was ≥ 1 ACEs, assessed via a validated questionnaire 24-48 h post-delivery. The primary outcome was opioid use (0-48 h) post-delivery in milligram morphine equivalents (MME). Pain was measured using the Short-Form Brief Pain Inventory (SF-BPI) 24-48 h postpartum and average numerical rating scale pain scores (recorded every 4 h). We used multivariable modified Poisson regression models to evaluate the association between ACEs and any opioid use, and multinomial regression to examine opioid dose quartiles.

Among 129 participants, 53 (41%) reported ≥ 1 ACEs. Women with ACEs were more likely to use opioids in the first 48 h postpartum than those without ACEs (89% vs. 59%, adjusted risk ratio [aRR] 1.52; CI 1.20, 1.91). ACEs were also associated with higher opioid dosage across quartiles: 2^nd [adjusted odds ratio (aOR) 8.60; CI 2.47, 29.9], 3^rd (aOR 5.74; CI 1.54-21.4), and 4^th (highest) [aOR 4.54; CI 1.30, 15.9] vs. the lowest quartile. Numerical rating scale pain scores were higher among women with ACEs (3/10 vs. 2/10, P = 0.037), as were SF-BPI worst pain scores (7/10 vs. 6/10, P = 0.029).

Adverse childoohd experiences were common and associated with higher opioid consumption and greater pain after cesarean delivery, supporting trauma-informed approaches to postpartum analgesia.