Maternal Childhood Trauma and Breastfeeding: A Systematic Review

Abstract

Background: Exclusive breastfeeding is the recommended source of nutrition for infants during the first six months of life; however, breastfeeding initiation, exclusivity, and duration can be influenced by numerous factors. Maternal adverse childhood experiences (ACEs), defined as exposure to adverse events before age 18 (e.g., abuse), have been increasingly examined in relation to breastfeeding outcomes. We conducted a systematic review (#CRD420251162871) to examine the association between maternal ACEs and breastfeeding outcomes, including initiation, duration, and exclusivity. Methodology: Search strategies were developed alongside librarians and conducted across eight electronic databases (CINAHL, Embase, LILACS, MEDLINE, PsycINFO, Scopus, Web of Science, SocINDEX). Eligible quantitative studies examined breastfeeding outcomes, including initiation, duration, and exclusivity, among mothers exposed to ACEs, measured using composite childhood trauma instruments that assessed three or more ACEs. Study screening was completed independently by two reviewers, and validity was assessed using the Critical Appraisal Skills Programme (CASP). Results: Nine full-text studies were included, comprising cross-sectional (n=4) and cohort (n=5) studies. Several studies reported associations between maternal ACE exposure and delayed breastfeeding initiation (n=2), reduced likelihood of exclusive breastfeeding (n=2), or earlier breastfeeding cessation (n=2), with stronger associations observed among those exposed to childhood sexual abuse. Other studies reported null findings (n=4), while some observed increased breastfeeding initiation among mothers with ACEs (n=2). Conclusion: Overall, findings suggest that there may be an association between maternal ACEs and breastfeeding outcomes, especially exclusive breastfeeding and earlier cessation, underscoring the importance of trauma-informed breastfeeding support. However, additional research is needed to better understand these associations.