TY - JOUR
T1 - Postpartum NSAID Use and Adverse Outcomes among Women with Hypertensive Disorders of Pregnancy
T2 - A Systematic Review and Meta-analysis
AU - Premkumar, Ashish
AU - Ayala, Nina K.
AU - Miller, Corinne H.
AU - Grobman, William A.
AU - Miller, Emily S.
N1 - Funding Information:
This study is supported by grant funding from Friends of Prentice (SP0051562) through Northwestern University.
Publisher Copyright:
© 2021 Thieme Medical Publishers, Inc.. All rights reserved.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Objective This study was aimed to perform a systematic review and meta-analysis of the association between postpartum nonsteroidal anti-inflammatory drug (NSAID) use among women with hypertensive disorders of pregnancy (HDP) and risks of adverse postpartum outcomes. Study Design Studies were eligible if they included women who had been diagnosed with HDP and were postpartum, reported exposure to NSAIDs, were written in English, and were published between January 2000 and November 2019. Assessment of bias was performed using the Newcastle-Ottawa scale for observational studies or the Cochrane Collaborative tool for randomized trials. The primary outcome was maternal blood pressure ≥ 150 mm Hg systolic and/or 100 mm Hg diastolic. Secondary outcomes were persistent blood pressures ≥ 160 mm Hg systolic and/or 110 mm Hg diastolic, mean arterial pressure (MAP), initiation or up-titration of antihypertensive medication, length of hospital stay, rehospitalization for blood pressure control, and postpartum opioid use. A random-effect meta-analysis was performed using RevMan, with a p -value < 0.05 used to indicate statistical significance (PROSPERO CRD no.: 42019127043). Results Among 7,395 abstracts identified, seven studies (four randomized and three cohort studies, n = 777 patients) met inclusion criteria. All cohort analyses exhibited low levels of bias, while two randomized controlled trials exhibited a high risk of bias in blinding and inclusion criteria. There was no association between NSAID use and blood pressures ≥ 150 mm Hg systolic and/or 100 mm Hg diastolic (risk ratio [RR]: 1.21, 95% confidence interval [CI]: 0.89-1.64). Conversely, NSAID use was associated with a statistically significant, but clinically insignificant, increase in length of postpartum stay (0.21 days, 95% CI: 0.05-0.38). No other secondary outcomes were significantly different between groups. Conclusion Postpartum NSAID use among women with HDP was not associated with maternal hypertension exacerbation. These findings support the recent American College of Obstetricians and Gynecologists' guideline change, wherein preeclampsia is no longer a contraindication to postpartum NSAID use. Key Points Postpartum (PP) NSAID use does not worsen hypertension in preeclampsia. PP NSAID use is associated with a longer, though clinically insignificant, length of stay. Our findings support ACOG's recommendations for PP NSAID use.
AB - Objective This study was aimed to perform a systematic review and meta-analysis of the association between postpartum nonsteroidal anti-inflammatory drug (NSAID) use among women with hypertensive disorders of pregnancy (HDP) and risks of adverse postpartum outcomes. Study Design Studies were eligible if they included women who had been diagnosed with HDP and were postpartum, reported exposure to NSAIDs, were written in English, and were published between January 2000 and November 2019. Assessment of bias was performed using the Newcastle-Ottawa scale for observational studies or the Cochrane Collaborative tool for randomized trials. The primary outcome was maternal blood pressure ≥ 150 mm Hg systolic and/or 100 mm Hg diastolic. Secondary outcomes were persistent blood pressures ≥ 160 mm Hg systolic and/or 110 mm Hg diastolic, mean arterial pressure (MAP), initiation or up-titration of antihypertensive medication, length of hospital stay, rehospitalization for blood pressure control, and postpartum opioid use. A random-effect meta-analysis was performed using RevMan, with a p -value < 0.05 used to indicate statistical significance (PROSPERO CRD no.: 42019127043). Results Among 7,395 abstracts identified, seven studies (four randomized and three cohort studies, n = 777 patients) met inclusion criteria. All cohort analyses exhibited low levels of bias, while two randomized controlled trials exhibited a high risk of bias in blinding and inclusion criteria. There was no association between NSAID use and blood pressures ≥ 150 mm Hg systolic and/or 100 mm Hg diastolic (risk ratio [RR]: 1.21, 95% confidence interval [CI]: 0.89-1.64). Conversely, NSAID use was associated with a statistically significant, but clinically insignificant, increase in length of postpartum stay (0.21 days, 95% CI: 0.05-0.38). No other secondary outcomes were significantly different between groups. Conclusion Postpartum NSAID use among women with HDP was not associated with maternal hypertension exacerbation. These findings support the recent American College of Obstetricians and Gynecologists' guideline change, wherein preeclampsia is no longer a contraindication to postpartum NSAID use. Key Points Postpartum (PP) NSAID use does not worsen hypertension in preeclampsia. PP NSAID use is associated with a longer, though clinically insignificant, length of stay. Our findings support ACOG's recommendations for PP NSAID use.
KW - NSAIDs
KW - hypertensive disorders of pregnancy
KW - nonsteroidal anti-inflammatory drugs
KW - postpartum
KW - preeclampsia
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U2 - 10.1055/s-0040-1713180
DO - 10.1055/s-0040-1713180
M3 - Review article
C2 - 32682329
AN - SCOPUS:85090300623
SN - 0735-1631
VL - 38
SP - 1
EP - 9
JO - American Journal of Perinatology
JF - American Journal of Perinatology
IS - 1
ER -