NSAIDs use safe in gestational hypertension, study challenges guidelines

Challenging current recommendations to avoid the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in women with hypertensive disorders of pregnancy, a new study finds that administration of NSAIDs for postpartum pain relief among women with hypertensive disorders of pregnancy is not associated with an increase in blood pressure.

Results of the retrospective cohort study are published in the journal Obstetrics & Gynecology.

Hannah B. Anastasio, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, and colleagues conducted the study to evaluate whether the administration of NSAID 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.

Also Read: NSAIDs use during late pregnancy may increase the risk of prematurity

The study is significant as in 2013 the American College of Obstetricians and Gynecologists (ACOG) made a recommendation against the use of NSAIDs in women with hypertensive disorders of pregnancy persisting for longer than 24 hours after delivery, the authors point out.

At that time, the Task Force on Hypertension in Pregnancy suggested that NSAIDs contributed to increased blood pressure in these women.

For this study, the authors retrospectively studied 276 women with hypertensive disorders of pregnancy. Patients were analyzed in two groups according to whether they received NSAIDs postpartum.

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.

Also Read: New ACOG guidelines on postpartum pain management

Key Findings:

• Postpartum NSAID administration was not associated with a statistically significant change in mean arterial pressure compared with no NSAID administration (20.7 versus 21.8 mmHg).


• There was also no difference in the need to start or increase the dose of antihypertensive agents or to rehospitalize new mothers for hypertensive disorder.


• In women who received NSAIDs, 35% were on antihypertensive medication antepartum compared with 22% of women who did not.

"These findings lead us to question the recommendation against use of NSAIDs postpartum in women with hypertensive disorders of pregnancy," write the authors.

The authors note that gestational disorders of pregnancy include gestational hypertension, preeclampsia, eclampsia, hemolysis, elevated liver enzymes, low platelet count syndrome, chronic hypertension, and superimposed preeclampsia.

"Our data suggest that administration of NSAIDs postpartum to women with hypertensive disorders of pregnancy is not associated with worsening hypertension and may be associated with less consumption of opioid pain medications during the inpatient postpartum course," they write.

"These findings lead us to question the recommendation against use of NSAIDs postpartum in women with hypertensive disorders of pregnancy," say Anastasio and colleagues.

"Larger studies, or meta-analysis of existing studies, may shed further light on rare adverse outcomes, which individual studies to date have been underpowered to evaluate."

The authors suggest that if clinicians did not have to avoid NSAIDs — "the mainstay" of postpartum analgesia — they would no longer have to resort to alternatives such as acetaminophen (Tylenol, Johnson & Johnson), opioids, gabapentin (Neurontin, Pfizer), or the lidocaine transdermal patch (Lidoderm, Endo Health Solutions).

"Increasing the use of opioid pain medication is particularly problematic in light of the present opioid use disorder epidemic," they explain. "Evaluating the safety of NSAID administration for postpartum women with hypertensive disorders is therefore important."

For further reference log on to 10.1097/AOG.0000000000002979

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