{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T18:04:54Z","timestamp":1789236294145,"version":"build-2803163510"},"reference-count":24,"publisher":"Georg Thieme Verlag KG","issue":"01","funder":[{"DOI":"10.13039\/100007059","name":"Northwestern University","doi-asserted-by":"crossref","award":["SP0051562"],"award-info":[{"award-number":["SP0051562"]}],"id":[{"id":"10.13039\/100007059","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>\n            Objective\u2003This 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.<\/jats:p><jats:p>\n            Study Design\u2003Studies 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\u2013Ottawa scale for observational studies or the Cochrane Collaborative tool for randomized trials. The primary outcome was maternal blood pressure \u2265\u2009150\u2009mm Hg systolic and\/or 100\u2009mm Hg diastolic. Secondary outcomes were persistent blood pressures \u2265\u2009160\u2009mm Hg systolic and\/or 110\u2009mm 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\u2009&lt;\u20090.05 used to indicate statistical significance (PROSPERO CRD no.: 42019127043).<\/jats:p><jats:p>\n            Results\u2003Among 7,395 abstracts identified, seven studies (four randomized and three cohort studies, n\u2009=\u2009777 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 \u2265\u2009150\u2009mm Hg systolic and\/or 100\u2009mm Hg diastolic (risk ratio [RR]: 1.21, 95% confidence interval [CI]: 0.89\u20131.64). 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\u20130.38). No other secondary outcomes were significantly different between groups.<\/jats:p><jats:p>\n            Conclusion\u2003Postpartum 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.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0040-1713180","type":"journal-article","created":{"date-parts":[[2020,7,18]],"date-time":"2020-07-18T22:31:42Z","timestamp":1595111502000},"page":"001-009","source":"Crossref","is-referenced-by-count":12,"title":["Postpartum NSAID Use and Adverse Outcomes among Women with Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-analysis"],"prefix":"10.1055","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6952-9955","authenticated-orcid":false,"given":"Ashish","family":"Premkumar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina K.","family":"Ayala","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinne H.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A.","family":"Grobman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily S.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,7,18]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1016\/S0140-6736(15)00070-7","article-title":"Pre-eclampsia","volume":"387","author":"B WJ Mol","year":"2016","journal-title":"Lancet"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1097\/AOG.0000000000001968","article-title":"Trends in maternal mortality by sociodemographic characteristics and cause of death in 27 states and the District of Columbia","volume":"129","author":"M F MacDorman","year":"2017","journal-title":"Obstet Gynecol"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1016\/S0002-9378(99)70615-0","article-title":"The effect of indomethacin and prostacyclin agonists on blood pressure in a rat model of preeclampsia","volume":"180","author":"M G Zlatnik","year":"1999","journal-title":"Am J Obstet Gynecol"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.ajog.2003.08.030","article-title":"Postpartum hypertension and nonsteroidal analgesia","volume":"190","author":"A Makris","year":"2004","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/0002-9378(89)90666-2","article-title":"Antagonism of antihypertensive drug therapy in pregnancy by indomethacin?","volume":"161","author":"A Schoenfeld","year":"1989","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref7","first-page":"CD004908","article-title":"Analgesia for relief of pain due to uterine cramping\/involution after birth","author":"A R Deussen","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"ref8","first-page":"CD011352","article-title":"Oral non-steroidal anti-inflammatory drugs (single dose) for perineal pain in the early postpartum period","volume":"7","author":"F Wuytack","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"issue":"01","key":"ref9","first-page":"e1","article-title":"ACOG practice bulletin no. 202: gestational hypertension and preeclampsia","volume":"133","author":"American College of Obstetricians and Gynecologists (ACOG)","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1097\/AOG.0000000000003020","article-title":"ACOG practice bulletin no. 203: chronic hypertension in pregnancy","volume":"133","author":"American College of Obstetricians and Gynecologists (ACOG)","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"27","key":"ref11","doi-asserted-by":"crossref","first-page":"iii","DOI":"10.3310\/hta7270","article-title":"Evaluating non-randomised intervention studies","volume":"7","author":"J J Deeks","year":"2003","journal-title":"Health Technol Assess"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"267","DOI":"10.7326\/M13-2886","article-title":"Random-effects meta-analysis of inconsistent effects: a time for change","volume":"160","author":"J E Cornell","year":"2014","journal-title":"Ann Intern Med"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"J P Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"M Egger","year":"1997","journal-title":"BMJ"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"b2535","DOI":"10.1136\/bmj.b2535","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"339","author":"D Moher","year":"2009","journal-title":"BMJ"},{"issue":"15","key":"ref17","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1001\/jama.283.15.2008","article-title":"Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group","volume":"283","author":"D F Stroup","year":"2000","journal-title":"JAMA"},{"issue":"06","key":"ref18","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1097\/AOG.0000000000002979","article-title":"Nonsteroidal anti-inflammatory drug administration and postpartum blood pressure in women with hypertensive disorders of pregnancy","volume":"132","author":"H B Anastasio","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"06","key":"ref19","doi-asserted-by":"crossref","first-page":"616.e1","DOI":"10.1016\/j.ajog.2018.02.016","article-title":"Effect of ibuprofen vs acetaminophen on postpartum hypertension in preeclampsia with severe features: a double-masked, randomized controlled trial","volume":"218","author":"N R Blue","year":"2018","journal-title":"Am J Obstet Gynecol"},{"issue":"11","key":"ref20","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1080\/14767058.2016.1210599","article-title":"Ibuprofen versus acetaminophen as a post-partum analgesic for women with severe pre-eclampsia: randomized clinical study","volume":"30","author":"P Vigil-De Gracia","year":"2017","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"04","key":"ref21","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1097\/AOG.0000000000002247","article-title":"Association of nonsteroidal anti-inflammatory drugs and postpartum hypertension in women with preeclampsia with severe features","volume":"130","author":"O A Viteri","year":"2017","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref22","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.preghy.2014.06.001","article-title":"Impact of non-steroidal anti-inflammatory drugs on hypertensive disorders of pregnancy","volume":"4","author":"S W Wasden","year":"2014","journal-title":"Pregnancy Hypertens"},{"issue":"06","key":"ref23","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1097\/AOG.0000000000003553","article-title":"Ibuprofen and postpartum blood pressure in women with hypertensive disorders of pregnancy: a randomized controlled trial","volume":"134","author":"C A Penfield","year":"2019","journal-title":"Obstet Gynecol"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.preghy.2019.09.012","article-title":"A randomized-controlled trial to assess the effect of ibuprofen on postpartum blood pressure in women with hypertensive disorders of pregnancy","volume":"18","author":"J E Triebwasser","year":"2019","journal-title":"Pregnancy Hypertens"},{"issue":"03","key":"ref25","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1002\/uog.21997","article-title":"Safety of non-steroidal anti-inflammatory drugs in the postpartum period among women with hypertensive disorders of pregnancy: a meta-analysis","volume":"56","author":"I Bellos","year":"2020","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1136\/bmj.a117","article-title":"Reasons or excuses for avoiding meta-analysis in forest plots","volume":"336","author":"J P Ioannidis","year":"2008","journal-title":"BMJ"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0040-1713180.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T23:31:42Z","timestamp":1609284702000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0040-1713180"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,18]]},"references-count":24,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2020,12,29]]},"published-print":{"date-parts":[[2021,1]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0040-1713180","relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,18]]}}}