The Effect of Nonsteroidal Anti-Inflammatory Medication on Postpartum Blood Pressure among Women with Preeclampsia: A Randomized Controlled Trial

One in twenty pregnant women will develop preeclampsia1, defined by new onset or worsening hypertension in the second half of pregnancy. Severe hypertension due to preeclampsia is associated with stroke, heart failure, and death.1 Historically, the use of NSAIDs in the postpartum period among women with preeclampsia has been associated with worsening of hypertension, and has not been recommended for use in this population.2-4 However, NSAIDs are one of the best medications for postpartum pain relief.5,6 The alternative to postpartum NSAIDs is prescription opioids, one of the leading factors contributing to the current opioid epidemic.5-7 Given these conflicting risks, there is clinical equipoise regarding postpartum NSAID use in the setting of preeclampsia. Recent studies question the association between NSAID use and hypertension during the inpatient postpartum period.8-10 However, none examine the risk of NSAID use and hypertension after discharge from the hospital or the role of avoiding NSAIDs in prescription opioid use. The proposed study will investigate whether NSAID use among postpartum women with preeclampsia leads to worsening of hypertension. Concomitantly, we will evaluate differences in patterns of prescription opioids caused by avoiding NSAIDs. These data will provide definitive answers to the management of postpartum pain in women with preeclampsia.