Childhood and Prenatal Stressors Shape Breastfeeding Behavior in Individuals with Opioid Use Disorder: A Prospective Investigation of Stress Effects.

Background: 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.