Effect of ibuprofen vs acetaminophen on postpartum hypertension in preeclampsia with severe features: a double-masked, randomized controlled trial

Blue, Nathan R.; Murray‐Krezan, Cristina; Drake-Lavelle, Shana; Weinberg, Daniel; Holbrook, Bradley D.; Katukuri, Vivek R.; Leeman, Lawrence; Mozurkewich, Ellen

doi:10.1016/j.ajog.2018.02.016

Cited by 31 publications

(24 citation statements)

References 32 publications

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“…One study was excluded after assessment of the full text because it evaluated the dose-dependent effects of ibuprofen on blood pressure postpartum but did not include a control group 22 . Therefore, this systematic review was based on 10 studies, comprising a total of 1647 patients [23][24][25][26][27][28][29][30][31][32] . All studies were evaluated qualitatively and eight of them were included in the quantitative meta-analysis.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…The outcomes of the Cochrane risk-of-bias assessment for the five RCTs are depicted in Figure 2. Briefly, three RCTs 26,28,32 were at low risk of bias in all domains, one open-label RCT 25 raised concerns owing to lack of participant and personnel blinding and lack of blinding of outcome assessment, and the other presented a high risk of attrition bias owing to failure to recruit the predefined sample size, and was terminated prematurely 23 . The results of the ROBINS-I tool assessment for the five cohort studies are presented in Table 2, indicating that the overall risk of bias ranged from low to moderate.…”

Section: Quality Assessmentmentioning

confidence: 99%

“…The outcomes of the qualitative synthesis are presented in Table 3. The incidence of severe postpartum hypertension was evaluated in four studies [25][26][27][28] , three of which found no significant difference between patients receiving ibuprofen and those receiving acetaminophen or not receiving NSAIDs [26][27][28] . On the other hand, the open-label RCT suggested that patients receiving ibuprofen, compared with acetaminophen, had a significantly higher risk of reaching a blood pressure of ≥ 150/100 mmHg 25 , although this association lost its significance when the threshold of 160/100 mmHg was used.…”

Section: Qualitative Synthesismentioning

confidence: 99%

“…On the other hand, the open-label RCT suggested that patients receiving ibuprofen, compared with acetaminophen, had a significantly higher risk of reaching a blood pressure of ≥ 150/100 mmHg 25 , although this association lost its significance when the threshold of 160/100 mmHg was used. Blood pressure was treated as a continuous variable in six studies 23,[26][27][28]30,31 , which indicated no increased values in systolic, diastolic or mean arterial pressure in patients receiving NSAIDs. A similar effect was observed when examining the change in blood pressure after NSAID administration in two of these studies 23,31 , demonstrating no significant rise compared with the control group.…”

Section: Qualitative Synthesismentioning

confidence: 99%

“…Moreover, treatment with NSAIDs did not lead to a need for increased doses of antihypertensive drugs and was not associated with readmission for hypertension. Interestingly, the study of Blue et al 28 indicated that treatment with ibuprofen did not affect the time needed to achieve blood pressure control and was not associated with adverse outcomes 6 weeks after delivery. Data about acute kidney injury risk were sparse, reported in only two studies, which showed no significant difference between the examined groups 27,31 .…”

Section: Qualitative Synthesismentioning

confidence: 99%

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Safety of non‐steroidal anti‐inflammatory drugs in postpartum period in women with hypertensive disorders of pregnancy: systematic review and meta‐analysis

Bellos

Pergialiotis

Antsaklis

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To assess the effect of non‐steroidal anti‐inflammatory drugs (NSAIDs) on blood pressure when administered for postpartum analgesia in women with hypertensive disorders of pregnancy. Methods MEDLINE, Scopus, CENTRAL, http://Clinicaltrials.gov and Google Scholar databases were searched systematically from inception to 5 December 2019 for studies evaluating the safety of postpartum NSAIDs in women with any gestational hypertensive disorder. Randomized controlled trials (RCTs) and cohort studies were eligible for inclusion. Case–control studies, case series and case reports were excluded. The primary outcomes of interest were the incidence of severe hypertension and systolic, diastolic and mean arterial blood pressure. Pooled estimates were obtained by fitting a random‐effects statistical model. The quality of evidence was assessed according to Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines. Results Ten studies were included, comprising five RCTs and five retrospective cohort studies and involving a total of 1647 women. All studies were evaluated qualitatively and eight of them were included in the quantitative meta‐analysis. Administration of NSAIDs was not associated with a significantly higher risk of severe postpartum hypertension (odds ratio, 1.52 (95% CI, 0.77–3.01)). Similarly, no significant differences were found in postpartum systolic blood pressure (mean difference (MD), –3.03 mmHg (95% CI, –6.21 to 0.15 mmHg)) and mean arterial pressure (MD, –0.38 mmHg (95% CI, –1.88 to 1.11 mmHg)) between women who received NSAIDs and those who did not, whereas postpartum diastolic blood pressure was marginally lower in women treated with NSAIDs (MD, –2.28 mmHg (95% CI, –4.44 to –0.13 mmHg)). The same effects were observed when studies with a large sample size, RCTs, women with severe pre‐eclampsia and studies using ibuprofen as the study drug and acetaminophen as the control treatment were examined separately. The credibility of evidence was judged to be very low according to GRADE, owing to concerns about study limitations, inconsistency and imprecision. Conclusions This meta‐analysis suggests that postpartum administration of NSAIDs is not associated with elevated blood pressure in women with hypertensive disorders of pregnancy. However, the existing evidence is of very low quality, thus future large‐scale RCTs are warranted to verify the safety of postpartum NSAIDs in this population. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Study Selection and Characteristicsmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

Section: Qualitative Synthesismentioning

confidence: 99%

Section: Qualitative Synthesismentioning

confidence: 99%

Section: Qualitative Synthesismentioning

confidence: 99%

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Safety of non‐steroidal anti‐inflammatory drugs in postpartum period in women with hypertensive disorders of pregnancy: systematic review and meta‐analysis

Bellos

Pergialiotis

Antsaklis

et al. 2020

Ultrasound in Obstet & Gyne

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Postpartum Ambulatory Blood Pressure Patterns Following New-Onset Hypertensive Disorders of Pregnancy

Hauspurg,

Venkatakrishnan,

Collins

et al. 2024

JAMA Cardiol

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ImportanceAfter a hypertensive disorder of pregnancy, hypertension can worsen in the postpartum period following hospital discharge. Risk factors for ongoing hypertension and associated outcomes have not been well characterized.ObjectiveTo identify risk factors and characterize outcomes for individuals with ongoing hypertension and severe hypertension following hospital discharge post partum through a hospital system’s remote blood pressure (BP) management program.Design, Setting, and ParticipantsThis cohort study involved a population-based sample of individuals with a new-onset hypertensive disorder of pregnancy (preeclampsia or gestational hypertension) and no prepregnancy hypertension who delivered between September 2019 and June 2021. Participants were enrolled in a remote BP monitoring and management program at a postpartum unit at a referral hospital. Data analysis was performed from August 2021 to January 2023.ExposureInpatient postpartum BP categories.Main Outcomes and MeasuresThe primary outcomes were readmission and emergency department visits within the first 6 weeks post partum. Logistic regression was used to model adjusted odds ratios (aORs) and 95% CIs.ResultsOf 2705 individuals in the cohort (mean [SD] age, 29.8 [5.7] years), 2214 (81.8%) had persistent hypertension post partum after hospital discharge, 382 (14.1%) developed severe hypertension after discharge, and 610 (22.6%) had antihypertensive medication initiated after discharge. Individuals with severe hypertension had increased odds of postpartum emergency department visits (aOR, 1.85; 95% CI, 1.17-2.92) and hospital readmissions (aOR, 6.75; 95% CI, 3.43-13.29) compared with individuals with BP normalization. When inpatient postpartum BP categories were compared with outpatient home BP trajectories to inform optimal thresholds for inpatient antihypertensive medication initiation, there was significant overlap between postdischarge BP trajectories among those with inpatient systolic BP greater than or equal to 140 to 149 mm Hg and/or diastolic BP greater than or equal to 90 to 99 mm Hg and those with systolic BP greater than or equal to 150 mm Hg and/or diastolic BP greater than or equal to 100 mm Hg.Conclusions and RelevanceThis cohort study found that more than 80% of individuals with hypertensive disorders of pregnancy had ongoing hypertension after hospital discharge, with approximately 14% developing severe hypertension. These data support the critical role of remote BP monitoring programs and highlight the need for improved tools for risk stratification and consideration of liberalization of thresholds for medication initiation post partum.

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Relief of pain due to uterine cramping/involution after birth

Deussen

Ashwood

Martis

et al. 2020

Cochrane Database of Systematic Reviews

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Effect of ibuprofen vs acetaminophen on postpartum hypertension in preeclampsia with severe features: a double-masked, randomized controlled trial

Cited by 31 publications

References 32 publications

Safety of non‐steroidal anti‐inflammatory drugs in postpartum period in women with hypertensive disorders of pregnancy: systematic review and meta‐analysis

Safety of non‐steroidal anti‐inflammatory drugs in postpartum period in women with hypertensive disorders of pregnancy: systematic review and meta‐analysis

Postpartum Ambulatory Blood Pressure Patterns Following New-Onset Hypertensive Disorders of Pregnancy

Relief of pain due to uterine cramping/involution after birth

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