A randomized trial of postpartum ibuprofen in severe hypertensive disorders of pregnancy

Ibuprofen has been shown to increase blood pressure in nonpregnant adults with hypertension, but its impact on blood pressure when used for postpartum analgesia in patients with a hypertensive disorder of pregnancy is less clear, particularly for those with severe hypertension.

To evaluate the impact of ibuprofen on postpartum blood pressure outcomes in patients with hypertensive disorders of pregnancy with severe hypertension.

In this randomized, double-blind trial, we randomly assigned patients with hypertensive disorders of pregnancy with severe hypertension to receive a postpartum analgesic regimen consisting of either ibuprofen 600 mg or acetaminophen 650 mg (control) every 6 hours. The primary outcome was severe hypertension during postpartum hospitalization. Secondary outcomes included other measures of blood pressure control such as antihypertensive medication use and average postpartum mean arterial pressure, and outpatient blood pressure as well as patient satisfaction, pain control, and diuresis. A sample size of 132 was needed to detect a 35% difference in severe postpartum hypertension.

We enrolled 140 participants from January 2017-October 2019. The prevalence of severe hypertension postpartum did not differ between participants receiving ibuprofen (38.6%) vs control (41.4%); the absolute difference was 2.8 percentage points, 95% confidence interval -13.1% to 18.5%, P=.73. There was no difference between the ibuprofen and control groups for antihypertensive medication use (35.7% vs 40.0%, P=.60) or average postpartum mean arterial pressure (95.7 ± 8.2 vs 95.9 ± 9.5, P=.91, respectively). Measures of outpatient blood pressure, patient satisfaction, diuresis, and pain control were also similar.

In patients with hypertensive disorders of pregnancy with severe hypertension, use of ibuprofen postpartum did not increase the prevalence of postpartum severe hypertension. Ibuprofen use did not impact other blood pressure outcomes, pain control, or patient satisfaction. These findings support ibuprofen use during the postpartum period in patients with hypertensive disorders of pregnancy.