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Ibuprofen and Postpartum Blood Pressure in Women With Hypertensive Disorders of Pregnancy

A Randomized Controlled Trial

Penfield, Christina A. MD, MPH; McNulty, Jennifer A. MD; Oakes, Megan C. MD; Nageotte, Michael P. MD

doi: 10.1097/AOG.0000000000003553
Hypertension: Original Research: PDF Only
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OBJECTIVE: To evaluate the effect of ibuprofen on blood pressure in women with a diagnosis of hypertensive disorders of pregnancy and mild hypertension during the immediate postpartum period.

METHODS: In this double-blind controlled trial, we randomly assigned women with a diagnosis of hypertensive disorders of pregnancy and mild hypertension to receive a postpartum analgesic regimen with either ibuprofen or acetaminophen. The primary outcome was average mean arterial pressure during the postpartum hospital stay. Prespecified secondary outcomes included use of breakthrough opioid pain medications, length of hospital stay, and postpartum diuresis, defined as urine output of at least 200 mL/hour for 4 hours. A sample size of 56 participants was needed to detect a difference of 6 mm Hg in average mean arterial pressure between the study groups.

RESULTS: From January 17, 2017, to February 24, 2018, 61 participants were randomized and completed the trial, 31 participants in the ibuprofen group and 30 in the control group. Baseline characteristics were similar between groups. Postpartum average arterial pressure did not differ between study groups (93±8 mm Hg for those in the ibuprofen group vs 93±7 mm Hg in the control group, P=.93). Breakthrough opioid medications were requested by 24% of the participants in the ibuprofen group compared with 30% in the control group (P=.62). The ibuprofen group did not have a longer length of stay (48 hours vs 43 hours in the control group) or decreased rate of postpartum diuresis (61% in ibuprofen group vs 77% in the control group, P=.2).

CONCLUSION: In women with hypertensive disorders of pregnancy and mild hypertension, ibuprofen did not increase postpartum blood pressure compared with women not receiving nonsteroidal antiinflammatory drugs.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT03011567.

Ibuprofen does not increase postpartum blood pressure in women with hypertensive disorders of pregnancy and mild hypertension.

Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Irvine, and the Department of Obstetrics and Gynecology, Miller Children's and Women's Hospital/Long Beach Memorial Medical Center, Long Beach, California.

Corresponding author: Christina A. Penfield, MD, MPH, Magella Medical Office, 2888 Long Beach Blvd. #400, Long Beach, CA 90806; email: penfieldca@gmail.com.

This study was funded by a grant from the MemorialCare Medical Center Foundation.

Financial Disclosure Christina A. Penfield disclosed receiving funds for a Medscape commentary. Jennifer A. McNulty disclosed that she is a full-time salaried physician employee of Mednax, providing obstetric care to women in a private practice. The other authors did not report any potential conflicts of interest.

Presented at the Society for Maternal-Fetal Medicine's 39th Annual Pregnancy Meeting, February 11–16, 2019, Las Vegas, Nevada.

The authors thank Deysi Caballero, RN, for her assistance in coordinating the trial.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/B605.

Received June 10, 2019

Received in revised form August 22, 2019

Accepted August 29, 2019

© 2019 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.