Safety of non‐steroidal anti‐inflammatory drugs in the postpartum period among women with hypertensive disorders of pregnancy: a meta‐analysis

OBJECTIVES: To assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on blood pressure when administered in women with gestational hypertensive disorders for postpartum analgesia. METHODS: Medline, Scopus, CENTRAL, Clinicaltrials.gov, Google Scholar databases were systematically searched from inception. All randomized controlled trials and cohort studies evaluating the safety of postpartum NSAIDs in women with any gestational hypertensive disorder were included. Case-control studies, case series and case reports were excluded. The primary outcomes of interest were incidence of severe hypertension, systolic, diastolic and mean arterial blood pressure. Pooled estimates were obtained by fitting a random-effects statistical model. RESULTS: Ten studies were included, comprising a total of 1,647 women. The administration of NSAIDs was not linked to significantly higher risk of severe postpartum hypertension (Odds Ratio-OR: 1.52, 95% Confidence Intervals-CI: 0.77, 3.01). Similarly, no significant differences were estimated for postpartum systolic blood pressure (Mean Difference-MD: -3.03 mmHg, 95% CI: -6.21, 0.15) and mean arterial pressure (MD: -0.38 mmHg, 95% CI: -1.88 to 1.11), while diastolic blood pressure was marginally lower in women treated with NSAIDs (MD: -2.28 mmHg, 95% CI: -4.44, -0.13). The same effects were estimated when studies with large sample size, randomized controlled trials, women with severe preeclampsia and studies using ibuprofen versus acetaminophen were separately examined. The credibility of evidence was judged to be very low due to concerns about study limitations, inconsistency and imprecision. CONCLUSIONS: The present meta-analysis suggests that postpartum NSAIDs are not associated with elevated blood pressure among women with gestational hypertensive disorders. The existing evidence is of very low quality and thus future large-scale randomized controlled trials are warranted to verify the safety of postpartum NSAIDs in this population. This article is protected by copyright. All rights reserved.