Infant Caregiving as a Resilience Factor for Postpartum Substance Misuse: A Scoping Review

The postpartum is a period of profound psychological and physiological change characterized by heightened vulnerability to return to substance misuse for individuals with a history of substance use disorder. Much existing research has focused on how postpartum substance use disrupts caregiving behaviors and adversely affects infant outcomes (i.e., risk frameworks). Comparatively little attention has been given to the potential for caregiving behaviors to serve as protective factors against postpartum substance use (i.e., resilience framework). This scoping review synthesized empirical studies examining caregiving behaviors as potential predictors of postpartum substance use outcomes, as thus far the inverse association has received greater attention in the literature. Following a systematic search of PubMed, Embase, PsycINFO, and Scopus (2000-2024), 42 studies met inclusion criteria, most of which assessed breastfeeding as a predictor of maternal substance use. Breastfeeding demonstrated consistent protective associations, particularly against postpartum nicotine use, with 28 of 30 studies reporting reduced smoking among breastfeeding mothers. Limited evidence also suggested protective effects of breastfeeding on alcohol, cannabis, and opioid use. Preliminary studies of other caregiving behaviors (i.e., skin-to-skin care, babywearing) indicated potential reductions in substance use urges and cigarette smoking. In several studies, contextual moderators (e.g., partner smoking, socioeconomic status) influenced the strength of these associations. Findings support the hypothesis that caregiving behaviors, especially those involving high physical touch, may reduce risk for postpartum substance misuse through neuroendocrine, psychological, and social mechanisms. However, research remains limited in scope and diversity. Expanding investigations beyond breastfeeding to include varied caregiving practices and caregiver populations could inform strengths-based, family-centered interventions that promote recovery and family well-being.