The Effect of Adverse Childhood Experiences on Inpatient Post-Cesarean Opioid Use [ID 3803]

INTRODUCTION: Opioid use disorder remains a leading cause of maternal morbidity and mortality. Adverse childhood experiences (ACEs) are a risk factor for the development of substance use disorder (SUD) and adverse health and pregnancy outcomes. We examined the association between ACE scores and inpatient post-cesarean opioid consumption. METHODS: We performed a retrospective cohort study of patients who underwent cesarean delivery from January 2022 to March 2024 and completed an ACE questionnaire during prenatal care. Postoperative morphine milliequivalents per day (MME/day) were compared between patients with high ACE scores (greater than 3) and those with low ACE scores (less than or equal to 3). Univariable analyses were performed to evaluate the association between ACE scores, demographic and clinical characteristics, and MME/day. Multivariable analyses were performed to adjust for confounders determined a priori. RESULTS: Five hundred sixty-four patients met the inclusion criteria for the study. Sixty-five patients had a high ACE score, and 499 patients had a low ACE score. In univariable analyses, patients with high ACE scores were more likely to have a history of SUD, chronic opioid use, or medication-assisted therapy use, and had higher median postoperative pain scores compared with patients with low ACE scores. In unadjusted analysis, those with high ACE scores had a significantly higher MME/day use (unadjusted difference 6.61; 95% CI, 2.50, 10.7). In multivariable analyses, these findings persisted (adjusted difference 5.97; 95% CI, 1.82, 10.12). CONCLUSIONS/IMPLICATIONS: High ACE scores were independently associated with higher post-cesarean opioid consumption. Findings could guide strategies to reduce postpartum opioid exposure.