Association of Mental Health Conditions, Recent Stressful Life Events, and Adverse Childhood Experiences with Postpartum Substance Use — Seven States, 2019–2020

What is already known about this topic? Most pregnancy-related deaths due to mental health conditions, including substance use disorder–related overdose and poisoning, occur during the late (43–365-day) postpartum period. What is added by this report? In seven states with high opioid-involved overdose mortality rates, depressive symptoms, depression, anxiety, adverse childhood experiences, and stressful life events were associated with higher substance and polysubstance use prevalences among postpartum women. Postpartum substance use prevalence was most common among women experiencing six or more stressful life events in the year before giving birth (67.1%) or four household-dysfunction adverse childhood experiences (57.9%). What are the implications for public health? Clinical and community- and systems-level interventions can address postpartum substance use and mental health conditions and lessen harms associated with adverse childhood experiences.