(1159) Maternal adverse childhood experiences and breastfeeding in low-come pregnant women: the CRADLE study

Objective:
Adverse childhood experiences (ACE) measures traumatic experiences like abuse, neglect and household disfunction. Higher scores are associated with chronic disease, mental health problems and risky health behaviors like substance use disorders. Evidence on the association between ACE and breastfeeding (BF) is inconsistent and largely based on mixed populations. Data from low-income cohorts are limited. We examined the relationship between ACE and BF initiation and continuation in a well-defined cohort of low-income pregnant women.

Study Design:
Secondary analysis of the Cradle randomized clinical trial evaluating group prenatal care. Participants completed surveys of demographics, health behaviors, measures of ACES, Perceived Stress and Shift and Persist scales. Medical records were abstracted for BF initiation at discharge and at 6 weeks postpartum. Participants were divided between low (0-3) and high (≥4) ACE scores. T-tests and chi-square tested differences between groups. Multivariable logistic regression adjusted for race and maternal age.

Results:

2255 participants were included. Most had low ACE scores (1796, 79.7%); 459 (20.4%) had high ACE scores. Participants with high scores were older (26.0 vs 25.3 years), less likely to be Black (28.8% vs 43.6%), more likely to speak English (90.0% vs 82.8%), more likely to drink alcohol during pregnancy (7.3% vs 3.4%) and smoke before (48.2% vs 34.5%) and during pregnancy (27.2% vs 16.4%), p < 0.01 for all. Participants with high scores demonstrated higher perceived stress scores (6.29 vs 4.74, p< 0.01) and fewer coping skills (3.4 vs 3.5, p< 0.01). Participants with high scores demonstrated higher rates of BF initiation (aOR 1.58, 95% CI 1.21-2.07) and at 6 weeks (aOR 1.49, 95% CI 1.15-1.95).

Conclusion:
Higher ACE scores were associated with higher rates of BF despite other negative health behaviors, higher stress and fewer coping skills in a low-income population. Future studies should explore the contributing factors of success in this group that can be leveraged for improving other health behaviors for patients with high ACE scores.