Understanding Postpartum Parent-Infant Relationships: Associations with Maternal Posttraumatic Stress and Opioid Cravings

Background and Purpose: Despite significant progress made by caregivers with histories of addiction to maintain sobriety and provide optimal care for their children, research has independently linked parental trauma symptoms and substance use to parent-infant relational challenges, including decreased parental sensitivity, elevated harshness, and intrusiveness (Hans et al., 2022). These challenges raise the possibility of child maltreatment and subsequent child welfare involvement and pose risks to child well-being and development (Hyysalo et al., 2022). Overall parenting practices for this population are not well understood across the first year of life, a high-risk period for mothers and babies alike where social workers are often involved. This study examines parent-infant interactions across the postpartum year among mothers with substance use disorder and/or opioid use disorder (SUD/OUD) and their infants to explore associations with posttraumatic stress symptoms and opioid cravings for the purpose of intervention development.

Methods: We conducted a prospective longitudinal study of postpartum mothers with SUD/OUD (N=24; M age= 33 years; 80% white; 68% HS/some college; 83% income < $20,000; majority taking medication for OUD) whose infants (M age= 5 months at baseline) were patients at a clinic for children impacted by parental SUD/OUD at a large safety net hospital. Participants were assessed across three timepoints during the postpartum year. The primary outcome was parent-infant interactions measured with the Coding Interactive Behaviors scales (CIB; Feldman, 1998), using composites for maternal sensitivity and responsiveness, intrusiveness, withdrawal, and dyadic reciprocity. We used mixed effects models to estimate associations among posttraumatic stress symptoms (assessed with PTSD Checklist-Short Form) and opioid cravings (assessed with the Opioid Craving Scale, representing sobriety challenges).

Results: Results revealed no statistically significant main effects of posttraumatic stress symptoms or opioid cravings on parent-infant interactions. However, in subsequent models, the interaction between posttraumatic stress symptoms and opioid cravings was significantly associated with aspects of parent-infant interactions (all p values < .05) indicating that the impact of posttraumatic stress on the parent-infant relationship was dependent on mother’s varying levels of opioid craving intensity, not on either measure alone. More specifically, the interaction term was associated with lower maternal sensitivity and responsiveness and dyadic reciprocity and higher maternal withdrawal and intrusiveness. These findings suggest that the relationship between posttraumatic stress and parenting should be understood in the context of craving severity among mothers in substance use recovery.

Conclusions and Implications: Findings demonstrate that trauma symptoms and recovery from substance/opioid use disorders have complex associations with parenting. This complexity has been incorporated into a perinatal intervention for mothers with SUD/OUD and their young children that is being disseminated nationally (Paris et al., In Press). The findings should also be addressed when developing social work policies to support mothers with SUD/OUD during the perinatal period. Continued examination of the multifaceted social, psychological, and physiological comorbidities that impact postpartum mothers with SUD/OUD and their infants can inform future social work parenting interventions for this population.