Perinatal opioid use disorder (OUD) remains prevalent in the United States and is associated with unfavorable breastfeeding outcomes, including low likelihood of initiation and decreased duration. Individuals with OUD face heightened risk for traumatic events across the life course, though we know little about how life stress impacts breastfeeding in those with OUD.
Method:
We investigated the differential and sequential impacts of adverse childhood experiences (ACEs) and past-year stressful life events (SLEs) on breastfeeding outcomes in a prospective cohort study of 50 pregnant individuals (100% identified as female, 42% non-Hispanic White, 42% Hispanic/Latina) in treatment for OUD, followed through 5 months postpartum.
Results:
Out of 50 participants, 37 (74.0%) initiated breastfeeding, 16 (32.0%) reported continued breastfeeding in any capacity at 2 months, and 5 (10%) reported exclusive breastfeeding at 2 months. Higher ACE scores were associated with increased odds of breastfeeding initiation (odds ratio [OR] = 3.48, 95% confidence interval [CI]: 1.11–16.34) and longer duration (B = 0.33, 95% CI: 0.04–0.60), suggesting resilience to early childhood adversity. Mediation analyses adjusted for demographic covariates revealed a significant indirect effect from higher ACEs to reduced likelihood of exclusive breastfeeding (β = −0.09, 95% CI: −0.09, −0.001, p = 0.04) via greater SLEs in the year prior to birth (β = 0.33, 95% CI: 0.06, 0.68, p = 0.01).
Conclusions:
Results highlight the importance of addressing both lifetime and recent trauma in clinical settings to improve breastfeeding outcomes in higher-risk populations. Interventions that incorporate social and behavioral support may be particularly beneficial to mitigate the negative impacts of stress on breastfeeding.
HaightSC, KoJY, TongVT, et al.Opioid use disorder documented at delivery hospitalization—United States, 1999–2014. MMWR Morb Mortal Wkly Rep, 2018; 67(31):845–849; doi: 10.15585/mmwr.mm6731a1
2.
KoJY, D’AngeloDV, HaightSC, et al.Vital signs: Prescription opioid pain reliever use during pregnancy—34 U.S. Jurisdictions, 2019. MMWR Morb Mortal Wkly Rep, 2020; 69(28):897–903; doi: 10.15585/mmwr.mm6928a1
3.
YonkeN, JimenezEY, LeemanL, et al.Breastfeeding motivators and barriers in women receiving medications for opioid use disorder. Breastfeed Med, 2020; 15(1):17–23; doi: 10.1089/bfm.2019.0122
4.
SchiffDM, WachmanEM, PhilippB, et al.Examination of hospital, maternal, and infant characteristics associated with breastfeeding initiation and continuation among opioid-exposed mother-infant dyads. Breastfeed Med, 2018; 13(4):266–274; doi: 10.1089/bfm.2017.0172
5.
DoerzbacherM, SperlichM, HequembourgA, et al.Scoping review of barriers and facilitators of breastfeeding in women on opioid maintenance therapy. J Obstet Gynecol Neonatal Nurs, 2022; 51(1):29–40; doi: 10.1016/j.jogn.2021.09.004
GoldshteinI, SadakaY, AmitG, et al.Breastfeeding duration and child development. JAMA Netw Open, 2025; 8(3):e251540; doi: 10.1001/jamanetworkopen.2025.1540
8.
Ray-GriffithS, TharpE, CokerJL, et al.Buprenorphine medication for opioid use disorder: A study of factors associated with postpartum treatment retention. Am J Addict, 2021; 30(1):43–48; doi: 10.1111/ajad.13084
9.
ChuL, McGrathJM, QiaoJ, et al.A Meta-Analysis of breastfeeding effects for infants with neonatal abstinence syndrome. Nurs Res, 2022; 71(1):54–65; doi: 10.1097/NNR.0000000000000555
10.
McCabeSE, CranfordJA, BoydCJ. Stressful events and other predictors of remission from drug dependence in the United States: Longitudinal results from a national survey. J Subst Abuse Treat, 2016; 71:41–47; doi: 10.1016/j.jsat.2016.08.008
11.
MeyerD, SiddiquiZ, DeolE, et al.Adverse childhood experiences and opioid use disorder: A systematic review. Psychoneuroendocrinology, 2023; 153:106224; doi: 10.1016/j.psyneuen.2023.106224
12.
FelittiVJ, AndaRF, NordenbergD, et al.Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. Am J Prev Med, 1998; 14(4):245–258; doi: 10.1016/S0749-3797(98)00017-8
13.
RegmiS, KediaSK, AhujaNA, et al.Association between adverse childhood experiences and opioid use-related behaviors: A systematic review. Trauma Violence Abuse, 2024; 25(3):2046–2064; doi: 10.1177/15248380231205821
14.
AlhowaymelFM, KalmakisKA, ChiodoLM, et al.Adverse childhood experiences and chronic diseases: Identifying a cut-point for ACE scores. Int J Environ Res Public Health, 2023; 20(2):1651; doi: 10.3390/ijerph20021651
15.
McCloskeyRJ, PeiF. Associations between mothers’ adverse childhood experiences, material hardship, and breastfeeding challenges in the United States. J Hum Lact, 2022; 38(4):651–660; doi: 10.1177/08903344221120596
16.
SørbøMF, LukasseM, BrantsæterA-L, et al.Past and recent abuse is associated with early cessation of breast feeding: Results from a large prospective cohort in Norway. BMJ Open, 2015; 5(12):e009240; doi: 10.1136/bmjopen-2015-009240
17.
UkahUV, AduPA, SilvaD, et al.The impact of a history of adverse childhood experiences on breastfeeding initiation and exclusivity: Findings from a national population health survey. Breastfeed Med, 2016; 11(10):544–550; doi: 10.1089/bfm.2016.0053
18.
WatsonC, WeiJ, VarnadoN, et al.Adverse childhood experiences and early and continued breastfeeding: Findings from an integrated health care delivery system. J Womens Health (Larchmt), 2021; 30(3):367–376; doi: 10.1089/jwh.2020.8697
19.
ZhengL, HunterK, BanksH-W, et al.Are maternal adverse childhood experiences (ACEs) and resilience associated with breastfeeding rates and neonatal growth? CRMJ, 2025; 6(1):1–11; doi: 10.31986/issn.2578.3343_vol6iss1.1
20.
QobadiM, CollierC, ZhangL. The effect of stressful life events on postpartum depression: Findings from the 2009–2011 Mississippi Pregnancy Risk Assessment Monitoring System. Matern Child Health J, 2016; 20(Suppl 1):164–172; doi: 10.1007/s10995-016-2028-7
21.
IslamMJ, BroidyL, BairdK, et al.Early exclusive breastfeeding cessation and postpartum depression: Assessing the mediating and moderating role of maternal stress and social support. PLoS One, 2021; 16(5):e0251419; doi: 10.1371/journal.pone.0251419
22.
BascomEM, NapolitanoMA. Breastfeeding duration and primary reasons for breastfeeding cessation among women with postpartum depressive symptoms. J Hum Lact, 2016; 32(2):282–291; doi: 10.1177/0890334415619908
23.
DozierAM, NelsonA, BrownellE. The relationship between life stress and breastfeeding outcomes among low-income mothers. Adv Prev Med, 2012; 2012(1):902487; doi: 10.1155/2012/902487
24.
KitsantasP, GaffneyKF, NirmalrajL, et al.The influence of maternal life stressors on breastfeeding outcomes: A US population-based study. The Journal of Maternal-Fetal & Neonatal Medicine, 2019; 32(11):1869–1873; doi: 10.1080/14767058.2017.1421929
25.
DugatVM, ChertokIRA, HaileZT. Association between stressful life events and exclusive breastfeeding among mothers in the United States. Breastfeed Med, 2019; 14(7):475–481; doi: 10.1089/bfm.2019.0058
26.
ShonkoffJP, GarnerAS, The Committee On Psychosocial Aspects Of Child And Family Health Coec Adoption, And Dependent Care, And Section On Developmental And Behavioral Pediatrics. The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 2012; 129(1):e232–e246; doi: 10.1542/peds.2011-2663
27.
HajatA, NuriusP, SongC. Differing trajectories of adversity over the life course: Implications for adult health and well-being. Child Abuse Negl, 2020; 102:104392; doi: 10.1016/j.chiabu.2020.104392
28.
Linde-KriegerLB, YatesTM. A structural equation model of the etiology and developmental consequences of parent-child role confusion. J Appl Dev Psychol, 2021; 72:101216; doi: 10.1016/j.appdev.2020.101216
29.
Sturge-AppleML, DaviesPT, CicchettiD, et al.Interparental violence, maternal emotional unavailability and children’s cortisol functioning in family contexts. Dev Psychol, 2012; 48(1):237–249; doi: 10.1037/a0025419
30.
AllenAM, Linde-KriegerLB, DeschenesJ, et al.Hormones and infant caregiving in postpartum opioid use disorder recovery: Compliance and satisfaction with a prospective cohort study protocol designed to identify novel support targets. medRxiv, 2024; doi: 10.1101/2024.12.14.24319034
31.
NewtonRW, WebsterPA, BinuPS, et al.Psychosocial stress in pregnancy and its relation to the onset of premature labour. Br Med J, 1979; 2(6187):411–413.
32.
AfifiAA, KotlermanJB, EttnerSL, et al.Methods for improving regression analysis for skewed continuous or counted responses. Annu Rev Public Health, 2007; 28(1):95–111; doi: 10.1146/annurev.publhealth.28.082206.094100
WhippsMDM. Education attainment and parity explain the relationship between maternal age and breastfeeding duration in U.S. mothers. J Hum Lact, 2017; 33(1):220–224; doi: 10.1177/0890334416679385
ClevelandLM. Breastfeeding recommendations for women who receive medication-assisted treatment for opioid use disorders: AWHONN Practice Brief Number 4. J Obstet Gynecol Neonatal Nurs, 2016; 45(4):574–576.
37.
LutharSS, CicchettiD. The construct of resilience: Implications for interventions and social policies. Dev Psychopathol, 2000; 12(4):857–885; doi: 10.1017/S0954579400004156
38.
NarayanAJ. Intergenerational resilience in the context of Adverse Childhood Experiences (ACEs). In: Handbook of Adverse Childhood Experiences: A Framework for Collaborative Health Promotion. (PortwoodSG, LawlerMJ, RobertsMC. eds) Springer International Publishing: Cham; 2023; pp. 13–27; doi: 10.1007/978-3-031-32597-7_2
39.
SchofieldTJ, CongerRD, NepplTK. Positive parenting, beliefs about parental efficacy, and active coping: Three sources of intergenerational resilience. J Fam Psychol, 2014; 28(6):973–978; doi: 10.1037/fam0000024
40.
Woods-JaegerBA, ChoB, SextonCC, et al.Promoting resilience: Breaking the intergenerational cycle of adverse childhood experiences. Health Educ Behav, 2018; 45(5):772–780; doi: 10.1177/1090198117752785
41.
RankinL, MendozaNS, GrishamL. Unpacking perinatal experiences with opioid use disorder: Relapse risk implications. Clin Soc Work J, 2023; 51(1):34–45; doi: 10.1007/s10615-022-00847-x
42.
SipsmaHL, JonesKL, Cole-LewisH. Breastfeeding among adolescent mothers: A systematic review of interventions from high-income countries. J Hum Lact, 2015; 31(2):221–229; quiz 321–322; doi: 10.1177/0890334414561264
43.
HenselD, HelouNE, ZhangF, et al.The impact of a multidisciplinary opioid use disorder prenatal clinic on breastfeeding rates and postpartum care. Am J Perinatol, 2024; 41(7):884–890; doi: 10.1055/s-0042-1748526
