Evidence Matters

Do NSAIDs Impact Postpartum Blood Pressure in Women with Hypertensive Disorder of Pregnancy?

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

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)

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

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

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