49: Should non-steroidal anti-inflammatory drugs be avoided in puerperal hypertensive women?

Abstract

Due to concerns for worsening hypertension, The Task Force for Hypertension in Pregnancy has recommended against the use of non-steroidal anti-inflammatory drugs (NSAID) in women with hypertension that persists >24h after delivery. This claim has not been validated in clinical studies involving puerperal women. Our objective was to determine whether NSAID exposure is associated with increased rates of postpartum hypertension (pHTN) requiring treatment in a cohort of women with preeclampsia and severe features (sPRE). We performed a retrospective case-control study of women with sPRE delivered at a single tertiary center from January 2013 to December 2015. Only women with pHTN 24h after delivery were included. The primary outcome was proportion of puerperal women who reached the blood pressure (BP) threshold for antihypertensive use (persistent SBP ≥150 and/or DBP ≥100 mmHg). Secondary outcomes included length of hospital stay, readmission due to pHTN and severe maternal morbidity (pulmonary edema, renal dysfunction or ICU admission). Multivariate logistic regression was performed to control for confounders: age, parity, BMI, diagnostic features for sPRE, gestational age (GA) and mode of delivery. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were reported for outcomes of interest. 14,372 women delivered during the study period and 399 (3%) were diagnosed with sPRE. Of the 324 (81%) eligible women, 243 (75%) received NSAID (cases) and 81 (25%) did not (controls). Although baseline characteristics between the groups were similar, women with evidence of laboratory abnormalities (28 vs 8%, p<0.001) were less likely to receive NSAID. Conversely, cesarean delivery was associated with higher rates of NSAID use (76 vs 61%, P=0.008). After logistic regression, NSAID were not associated with increased rates of pHTN requiring treatment, length of hospital stay, readmission or severe morbidity (Table). Furthermore, postpartum BP trends were similar between cases and controls (Figure). In women with sPRE and pHTN 24h after delivery, NSAID were not associated with increased rates of pHTN requiring antihypertensives. Given the relative safety of NSAID over opioids in puerperal women, prospective studies evaluating the effect of NSAID in this population are warranted before recommendations forfeiting their use are made.View Large Image Figure ViewerDownload Hi-res image Download (PPT)