(699) A randomized trial of the impact of postpartum ibuprofen on severe hypertensive disorders of pregnancy

To evaluate the impact of ibuprofen on postpartum (PP) blood pressure (BP) outcomes in pregnant patients with a new diagnosis of hypertensive disorders of pregnancy (HDP) and antenatal severe hypertension.

Study Design: In this double-blind randomized controlled trial, participants with HDP with antenatal severe hypertension (systolic BP > 160 or diastolic > 105mmHg) were assigned to receive a PP scheduled analgesic regimen with either ibuprofen or acetaminophen (control). Scheduled antihypertensive medications were started PP only as needed to maintain BP < 150/100. The primary outcome was prevalence of severe hypertension during PP stay. Prespecified secondary outcomes included need for PP anithypertensive medication, escalation of scheduled antihypertensive regimen, average PP mean arterial pressure (MAP), patient satisfaction, breakthrough pain medication, PP length of stay (LOS), and diuresis (urine output > 200 ml/hour for 4 hours).

Results: From January 2017 to October 2019, 140 participants were randomized. Baseline characteristics were similar (Table 1). Prevalence of PP severe hypertension did not differ between groups (39.1% for those receiving ibuprofen vs 41.4% for controls, p=0.78, Table 2). There was no difference in PP antihypertensive medication use (35.7% in the ibuprofen group vs 40.0% for controls, p=0.60), nor escalation of scheduled antihypertensive regimen (15.7% in both groups, p=1.0). Mean MAP was similar between ibuprofen and control groups (95.7+8.2 vs 95.9+9.5, respectively, p=0.91). Diuresis occurred in 64.7% of the ibuprofen group vs 65.7% in controls (p=0.90). Patient satisfaction, breakthrough pain medication, and LOS were similar.

Conclusion: In patients with antenatal HDP and severe hypertension, PP ibuprofen use did not increase the prevalence of severe hypertension compared to those not receiving nonsteroidal antiinflammatory drugs (NSAIDs). Ibuprofen use did not impact other BP outcomes, pain control, or patient satisfaction. These findings from the largest trial to date support ACOG’s recommendation that NSAIDs should be used preferentially over opioid analgesics.