Postpartum Hypertension in Preeclampsia: Do Puerperal NSAIDs Effect Risk?

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Rates of eclampsia, pulmonary edema, and ICU admission were similar between women who received NSAIDs and those who did not.
Rates of eclampsia, pulmonary edema, and ICU admission were similar between women who received NSAIDs and those who did not.

The use of puerperal nonsteroidal anti-inflammatory drugs (NSAIDs) is not associated with a significantly increased risk for postpartum hypertension in women with preeclampsia, according to a retrospective study published in Obstetrics & Gynecology.

Investigators of this study retrospectively evaluated outcomes in women with a preeclampsia diagnosis who received NSAIDs and in whom hypertension developed for >24 hours following delivery (n=243). For comparison, investigators evaluated similar patients who did not receive NSAIDs (n=81). Primary outcome comprised the persistent postpartum hypertension rate, defined as at least 2 occasions of systolic blood pressure of ≥150 mm Hg and/or diastolic blood pressure ≥100 mm Hg.

No differences were found with regard to the primary outcome between those receiving vs those not receiving NSAIDs (70% vs 73%; adjusted odds ratio [aOR], 1.1; 95% CI, 0.6-2.0). In addition, investigators observed no difference between the 2 groups with regard to the incidence of eclampsia (1% vs 0%; P =.34), pulmonary edema (3% vs 10%; aOR, 4.4; 95% CI, 1.5-13.1), intensive care unit admission (3% vs 8%; aOR 2.4; 95% CI, 0.8-7.1), or renal insufficiency (5% vs 8%; aOR, 1.7; 95% CI, 0.6-4.8). The rates of narcotics use were also similar for the 2 groups (89% vs 75%; aOR, 0.6; 95% CI, 0.18-1.70).

However, antihypertensive and NSAID treatment data after hospital discharge were not available, which limited the investigators' findings. In addition, there was not a balanced number of women in each study group, although the sample size was deemed adequate enough to identify significant differences between the 2 groups.

Investigators of this study believe that further research is needed on the use of NSAIDs in this patient population “given the relative safety of NSAIDs over opioids in nursing women and because of increasing concerns regarding narcotic dependence … before recommendations forfeiting NSAID use in this population are made.”

Reference

Viteri OA, England JA, Alrais MA, et al. Association of nonsteroidal antiinflammatory drugs and postpartum hypertension in women with preeclampsia with severe features. Obstet Gynecol. 2017;130(4):830-835.

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