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Faculty have requested this content not be shared on social media
CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
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Poster Session 1

(318) Adverse childhood experiences are associated with higher opioid use and pain after cesarean delivery

Thursday, January 30, 2025
10:30 AM – 12:30 PM  
Objective:

Adverse childhood experiences (ACEs) have been linked with increased post-operative pain and opioid use, yet they have been understudied in the postpartum period. We evaluated whether ACEs were associated with opioid use and pain after cesarean delivery (CD).

Study Design:

This was a prospective cohort study of pregnant people who delivered a singleton liveborn infant via CD with neuraxial anesthesia in 2023-2024. We included those aged 18-55 years, literate in English or Spanish, and with no second stage of labor. The exposure was a history of any ACEs, derived from a validated questionnaire administered 24-48 hours (h) post-CD. The primary outcome was opioid use 0-48h post-CD in milligram morphine equivalents (MME). Pain was measured from average numerical rating pain scores (every 4h over 72h) and a validated questionnaire (Short-Form Brief Pain Inventory, SF-BPI) 24-48h post cesarean. Multivariable multinomial regression models were used, adjusting for confounders. Sample size was determined using an effect size of 20%.

Results:

Among 134 participants, 55 (41%) had ACEs and 79 (59%) did not. Despite similar postpartum lengths of stay, median total MMEs during the postpartum admission was 23 (Q1-Q3 13-62) in people with ACEs and 11 (Q1-Q3 0-44, p=0.01) in those without ACEs. In the first 48h, compared with the 1st (lowest) quartile of MME use, people with ACEs were more likely to use amounts in the 2nd [adjusted odds ratio (aOR) 7.97; CI 2.43-26.2], 3rd (aOR 4.41; CI 1.26-15.5), and 4th (highest) MME quartiles (aOR 3.60; CI 1.09-11.8) than people without ACEs (Table 1). Pain scores also differed; those with ACEs rated their average pain as 3/10 compared with 2/10 in those without ACEs (p=0.02, Table 1, Figure 1).

Conclusion:

Postpartum people with ACEs used more opioids and experienced more pain after CD compared to people without ACEs. These results highlight the importance of integrating trauma-informed care into peri-operative protocols, which could improve pain management and reduce opioid reliance after CD for people with a history of ACEs.