BACKGROUND AND PURPOSE:

• Hypertensive disorders of pregnancy include
  • Gestational hypertension | Preeclampsia | Eclampsia | HELLP | Chronic hypertension | Superimposed preeclampsia
• In nonpregnant hypertensive patients, NSAIDs are associated with risk of BP elevation
• Anastasio et al. (Obstetrics & Gynecology, 2018) assessed whether postpartum nonsteroidal anti-inflammatory drug (NSAID) administration is associated with
  • BP elevation in the setting of hypertensive disorders in pregnancy
  • Use of opioid medication

METHODS:

• Retrospective cohort study
  • Women with hypertensive disorders of pregnancy
• Exposure: Received NSAIDs postpartum
• Primary outcome: Change in mean postpartum arterial pressure
• Secondary outcomes
  • Postpartum pain scores | Cumulative postpartum opioid requirement | Initiation or dose escalation of antihypertensive agents | Adverse postpartum outcomes (acute renal failure, change in hematocrit, maternal readmission for hypertensive disorder)

RESULTS:

• 267 women with hypertensive disorders of pregnancy were included
  • 129 NSAID-unexposed
  • 147 NSAID-exposed
• Postpartum NSAID administration was not associated with a statistically significant change in mean arterial pressure
  • Change in mean arterial pressure: −0.7 vs −1.8
  • Mean difference 1.10 (95% CI −1.44 to 3.64)
• No difference was observed between the cohorts for the following
  • Initiation or escalation in dose of antihypertensive agents
  • Maternal readmission for hypertensive disorder
  • Adverse postpartum outcomes (although study was underpowered for secondary outcomes)
  • Difference in opioid use

CONCLUSION:

• There were no significant differences between those women exposed vs unexposed to NSAIDs
• These results reinforce other studies that have also demonstrated no association between NSAID use and increase in postpartum BP in women with hypertensive disorders of pregnancy

Learn More – Primary Sources:

Nonsteroidal Antiinflammatory Drug Administration and Postpartum Blood Pressure in Women With Hypertensive Disorders of Pregnancy

Related ObG Topics:

Does Ibuprofen Increase the Risk for Postpartum Hypertension in the Setting of Preeclampsia?

Are NSAIDs (Single Dose) Effective at Reducing Perineal Pain Post Childbirth?

Are NSAIDs Associated with Persistent Postpartum Hypertension in Women with Preeclampsia?

Managing Pain in the Postpartum Period: Recommendations Using the Multimodal Approach