Effect of ibuprofen versus acetaminophen on postpartum hypertension: a systematic review and meta-analysis of randomized controlled trials
Abstract
Hypertensive disorders of pregnancy (HDP) increase postpartum morbidity and the need for effective pain management, particularly after cesarean delivery. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are effective analgesics but have historically been avoided in women with HDP due to potential blood pressure (BP) elevation. Current guidelines support postpartum NSAID use, but evidence remains limited. This systematic review and meta-analysis aim to evaluate the safety of ibuprofen compared with acetaminophen for postpartum BP control in women with HDP. Following PRISMA guidelines, PubMed, Ovid Medline, and the Cochrane Library were searched for randomized controlled trials (RCTs). Risk of bias was evaluated using the Cochrane RoB2 tool, and meta-analyses were performed using RevMan software. Six RCTs including 535 patients were included. Of these, 269 (50.3%) were assigned to the ibuprofen group, with a mean age of 30.20 ± 6.07 years; and 266 (49.7%) were assigned to the acetaminophen group, with a mean age of 29.14 ± 6.42 years. Pooled analyses showed no significant differences between ibuprofen and acetaminophen in severe postpartum hypertension (OR 1.15, 95% CI 0.75–1.75), systolic BP (MD 1.31 mmHg, 95% CI −1.60 to 4.22), diastolic BP (MD 1.81 mmHg, 95% CI −0.26 to 3.88), mean arterial pressure (MD 0.03 mmHg, 95% CI −1.82 to 1.88), or antihypertensive use (OR 1.00, 95% CI 0.61–1.63). Secondary outcomes, including time to BP control, hospital stay,…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 535 participants or records.
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