Postpartum NSAID Use and Adverse Outcomes among Women with Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-analysis

2020 ◽  
Vol 38 (01) ◽  
pp. 001-009
Author(s):  
Ashish Premkumar ◽  
Nina K. Ayala ◽  
Corinne H. Miller ◽  
William A. Grobman ◽  
Emily S. Miller

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

Author(s):  
Rouhina Movaghar ◽  
Azizeh Farshbaf-Khalili ◽  
khadijeh Hajizade ◽  
Mehdi Ebrahimpour MirzaRezaei ◽  
Mahnaz Shahnazi

AbstractIntroduction:Antioxidants and anti-inflammatory drugs have been suggested to treat preeclampsia. This systematic review and meta-analysis was conducted to investigate the efficacy of probiotic or synbiotic supplementation on hypertensive disorders in women with gestational diabetes mellitus (GDM).Methods:The databases including Cochrane, Embase, Ovid, ProQuest, Scopus, Web of Science, and PubMed were systematically searched for collecting the randomized controlled trials (RCTs) investigating the efficacy of probiotic or synbiotic supplementation versus placebo on hypertensive disorders and pregnancy outcomes in GDM until July 2020.Results:Five RCTs with a total sample size of 402 women were included in the meta-analysis. There was no significant decline in systolic blood pressure (standardized mean difference [SMD] = -3.41, 95% confidence interval [CI] = -8.32 to 1.50, P = 0.17), diastolic blood pressure (SMD = -5.11, 95% CI = -14.20 to -3.98, P = 0.27), preeclampsia (odds ratio [OR] = 1.56, 95% CI = 0.61 to 3.98, P = 0.35), cesarean section (OR = 0.52, 95% CI = 0.18 to 1.50, P = 0.23), and macrosomia (OR = 0.81, 95% CI = 0.41 to 1.57, P = 0.53). No significant increase was observed in terms of 5-minute Apgar (SMD = 0.16, 95% CI = -0.06 to 0.39, P = 0.15, I2= 0%), birth weight (SMD = -0.18, 95% CI = -0.43 to 0.06, P = 0.13, I2= 0%), and gestational age (SMD = 0.13, 95% CI = -0.11 to 0.37, P = 0.28, I2= 0%).Conclusion:Probiotic or synbiotic supplements are not associated with significant effects on pregnancy outcomes in GDM. However, due to the limited number of studies in this regard and heterogeneity between studies, future high-quality RCTs are recommended.


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