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

Anastasio, Hannah B., MD; Campbell, Lauren E., MD; Buermeyer, Alison, BS; Saccone, Gabriele, MD; Moreno, Sindy, MD; Cruz, Yuri, MD; Berghella, Vincenzo, MD; Schoen, Corina, MD; Roman, Amanda, MD

doi: 10.1097/AOG.0000000000002979
Hypertension: Original Research: PDF Only

OBJECTIVE: To evaluate whether postpartum nonsteroidal antiinflammatory drug (NSAID) administration is associated with increased blood pressure in women with hypertensive disorders of pregnancy and to estimate the association between NSAID administration and use of opioid medication.

METHODS: We conducted a retrospective cohort study of women with hypertensive disorders of pregnancy. Patients were analyzed in two groups according to whether they received NSAIDs postpartum. Study participants were women delivered at a tertiary care center from 2008 to 2015. The primary outcome was change in mean arterial pressure during the postpartum period. Secondary outcomes were postpartum pain scores, cumulative postpartum opioid requirement, initiation or dose escalation of antihypertensive agents, and adverse postpartum outcomes including acute renal failure, change in hematocrit, and maternal readmission for hypertensive disorder.

RESULTS: Two hundred seventy-six women with hypertensive disorders of pregnancy were included (129 NSAID-unexposed and 147 NSAID-exposed). Postpartum NSAID administration was not associated with a statistically significant change in mean arterial pressure compared with no NSAID administration (−0.7 vs −1.8; mean difference 1.10, 95% CI −1.44 to 3.64). Similarly, no difference was observed between the cohorts in terms of need for initiation or escalation in dose of antihypertensive agents or maternal readmission for hypertensive disorder. The study was underpowered to determine whether NSAID administration was associated with any difference in less frequent secondary outcomes (eg, incidence of acute renal insufficiency, need for postpartum transfusion) or cumulative opioid use.

CONCLUSION: Nonsteroidal antiinflammatory drug administration to postpartum patients with hypertensive disorders of pregnancy is not associated with a change in blood pressure or requirement for antihypertensive medication.

Postpartum administration of nonsteroidal antiinflammatory drugs to women with hypertensive disorders is not associated with increased blood pressure.

Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; the Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; the Obstetrics and Gynecology Department, Flushing Hospital Medical Center, Flushing New York; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts–Baystate, Springfield, Massachusetts.

Corresponding author: Hannah B. Anastasio, MD, 833 Chestnut Street, First Floor, Philadelphia, PA 19107; email: Hannah.Anastasio@jefferson.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the Society for Maternal-Fetal Medicine’s 38th Annual Pregnancy Meeting, January 29–February 3, 2018, Dallas, Texas.

Peer review history is available at http://links.lww.com/AOG/B190.

Each author has indicated that he or she has met the journal’s requirements for authorship.

Received July 20, 2018

Received in revised form September 05, 2018

Accepted September 20, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.