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

Abstract

Background: 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.

Methods: 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.

Results: 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).

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

Keywords: Adverse childhood experiences; Cesarean; Obstetrics; Opioid; Pain; Pregnancy; Trauma-informed care.