Retrospective Review of NSAIDS in the Postpartum Period
| Status: | Enrolling by invitation |
|---|---|
| Healthy: | No |
| Age Range: | 12 - 45 |
| Updated: | 4/22/2017 |
| Start Date: | January 18, 2017 |
| End Date: | April 2019 |
Hypertension and NSAIDS in the Postpartum Period
Chart review of women who have delivered an infant in a single health care system to
determine if NSAID use increases blood pressures in the postpartum period.
determine if NSAID use increases blood pressures in the postpartum period.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common medication used for pain
relief in the postpartum period in the United States. For pain relief of uterine involution,
NSAIDs have shown to be superior to placebo, and equivalent or superior to narcotics. In
2013 the American College of Obstetricians and Gynecologists (ACOG) discouraged the use of
NSAIDs in women with pre-eclampsia due to concerns for inadvertently increasing blood
pressure. This recommendation is based on non-obstetrics literature, which tended to show a
small increase of blood pressures in patients who use NSAIDS. However the literature is
mixed, particularly on ibuprofen which is the most common NSAID used in the postpartum. Of
the two meta-analysis that are commonly referenced, Pope et al found a decrease of -0.3 (+/-
2.57) mmHg in mean arterial pressure (MAP) in patients with hypertension treated with
ibuprofen, and Johnson et al identified an average of 5mmHg increase in blood pressure with
ibuprofen use. A large study of 18,325 patients who were treated with NSAIDS or COX-2
inhibitors, found an average of a 2.1 (+/- 0.5) mmHg increase in blood pressure with
ibuprofen administration.
There are two articles available in the obstetrics literature on the topic of NSAIDS in
women with hypertension disorders. The first is by Makis et al, and is a case series of six
women, with discussion of two cases. The explanations of hypertension causes are limited and
possible alternate diagnoses are not discussed (6). The second by Wasden et al is a
retrospective study of women who had the diagnosis of severe hypertension disorders in
pregnancy. The patients were matched 2:1 for women exposed to NSAIDs versus those who did
not receive NSAIDs. MAPs were compared, and there was no difference found between the two
groups. This second study is better designed and is likely representative of the true
outcome of NSAID use in pre-eclamptic women, as the general literature shows a small,
non-clinically significant change in blood pressure readings.
relief in the postpartum period in the United States. For pain relief of uterine involution,
NSAIDs have shown to be superior to placebo, and equivalent or superior to narcotics. In
2013 the American College of Obstetricians and Gynecologists (ACOG) discouraged the use of
NSAIDs in women with pre-eclampsia due to concerns for inadvertently increasing blood
pressure. This recommendation is based on non-obstetrics literature, which tended to show a
small increase of blood pressures in patients who use NSAIDS. However the literature is
mixed, particularly on ibuprofen which is the most common NSAID used in the postpartum. Of
the two meta-analysis that are commonly referenced, Pope et al found a decrease of -0.3 (+/-
2.57) mmHg in mean arterial pressure (MAP) in patients with hypertension treated with
ibuprofen, and Johnson et al identified an average of 5mmHg increase in blood pressure with
ibuprofen use. A large study of 18,325 patients who were treated with NSAIDS or COX-2
inhibitors, found an average of a 2.1 (+/- 0.5) mmHg increase in blood pressure with
ibuprofen administration.
There are two articles available in the obstetrics literature on the topic of NSAIDS in
women with hypertension disorders. The first is by Makis et al, and is a case series of six
women, with discussion of two cases. The explanations of hypertension causes are limited and
possible alternate diagnoses are not discussed (6). The second by Wasden et al is a
retrospective study of women who had the diagnosis of severe hypertension disorders in
pregnancy. The patients were matched 2:1 for women exposed to NSAIDs versus those who did
not receive NSAIDs. MAPs were compared, and there was no difference found between the two
groups. This second study is better designed and is likely representative of the true
outcome of NSAID use in pre-eclamptic women, as the general literature shows a small,
non-clinically significant change in blood pressure readings.
Inclusion Criteria:
- received NSAIDs post delivery for pain
Exclusion Criteria:
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